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Demonstration of a Process-Outcome Link for Smoking Cessation

Demonstration of a Process-Outcome Link for Smoking Cessation. Melissa M. Farmer, PhD 1,2 Elizabeth M. Yano, PhD 1,2 Brian S. Mittman, PhD 1,2 Scott E. Sherman, MD, MPH 1,3.

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Demonstration of a Process-Outcome Link for Smoking Cessation

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  1. Demonstration of a Process-Outcome Link for Smoking Cessation Melissa M. Farmer, PhD1,2 Elizabeth M. Yano, PhD1,2 Brian S. Mittman, PhD1,2 Scott E. Sherman, MD, MPH1,3 1VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior; UCLA Schools of Public Health2 and Medicine3 AcademyHealth Annual Meeting • Boston • June 2005

  2. Background: Smoking Cessation (SC) • Nearly 25% of all Americans are smokers • SC has one of the lowest treatment delivery rates of all preventive services. • Many SC interventions work • NRT and/or buproprion • SC programs • Brief provider tobacco counseling

  3. Background: Why the VA? • Smoking is more prevalent among veterans. • VA is the largest health care system in U.S. • Currently ~6 million VA users: ~2 million smokers • Increased SC guideline adherence was among VA’s first national performance goals • Substantial improvements in detecting and counseling smokers

  4. QUITS Intervention • Evidence-based quality improvement (QI) guideline implementation study at 18 Southwestern VA’s in 1998-2002 • Intervention did not result in higher quits or quit attempts • More research needed on contribution of setting and the process of care Funded by VA Health Services Research & Development Service

  5. Objectives • Examine the relationship between discrete site-level process-of-care measures and clinical outcomes for smoking cessation (30-day abstinence) in a representative sample of VA primary care patients

  6. Sample and Methods • Site-level data: Primary/Ambulatory care manager survey (n=18) • Assessment, counseling, referral to SC programs, treatment & resources available • Patient-level data: Telephone survey data from QUITS sample of veterans smokers • Baseline (n=1941), 12 month follow-up (n=1038) and 18 month follow-up (n=885). • Sociodemographics, health status, smoking status

  7. Analytic Strategy • Logistic regression with cluster-adjustment at the site-level to examine process-quality measures as predictors of successful smoking cessation outcomes • controlling for patient characteristics, baseline health and smoking status.

  8. Facility Characteristics (n=18) * 3 point scale: 1=less than half, 2=most, 3=all or almost all patients

  9. Facility Characteristics (n=18)

  10. Patient Population (n=1038)

  11. Results

  12. Logistic Model for 30-day abstinence

  13. Summary of Results: • At 12- months increased odds of abstinence at sites that report more frequent assessment, counseling and referrals. • At 18-months, odds were further increased by sites that report more frequent assessment and counseling. • Those sites that monitored their own performance for tobacco use assessment had higher odds of abstinence at 12 and 18-months.

  14. Limitations • Results limited to QUITS sample of facilities and patients • Future research needed on the measurement of process-of-care

  15. Conclusions and Implications • Site-level process-of-care measures predict clinical outcomes for smoking cessation. • The demonstration of a process-outcome link between smoking cessation performance measures and veterans’ actual cessation supports VA’s process measurement as a valid marker for ultimately helping veterans quit smoking.

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