Interventions to Implement a Clinic-Based Smoking Cessation Guideline Within a Staff Model HMO

Abstract

Smoking cessation guideline development has become widespread, outpacing guideline implementation efforts. To address this problem, HealthPartners undertook a randomized trial of strategies to enhance compliance of a smoking cessation guideline. The intervention aimed at clinic leadership resulted in significantly more compliance, as measured by physicians coding "tobacco use" on a billing form. The intervention aimed at all clinic physicians had no significant effect. The study suggests that smoking cessation guideline efforts should focus on clinic leadership and system changes rather than on all staff physicians.

Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review

“…In six RCTs (16, 22–25, 28), one CCT (29) and two BA studies (15, 17), there was no significant effect of the intervention on process measures. In seven studies, a significant effect on provider performance was reported in the publication.…”

“…Two studies focused primarily on CQI (21 CQI study, 22) using system support interventions such as training or supervision of pharmacists, instruction teams and provider feedback. Two studies relied primarily on marketing techniques (27, 28) with only one study using explicit psychological theories to overcome obstacles facing providers or healthcare organizations (27). Provider audit and feedback was evaluated within multifaceted implementation programmes backed by reminder systems (only algorithms: 30), AD (15, 27) or AD, continuous clinical co‐ordination and support and combined patient and family interventions (18–20).…”

“…Most follow‐up measurements of provider performance and patient outcomes were performed 12 months after intervention start (18–23, 25, 27, 31). A minority of studies had follow‐up measurements at 6 months (15, 24, 26, 29–30), 4 months (16), 3 months (28) or only 2 months (17).…”

“…All 18 studies measured provider performance (Table 2), mostly by reviewing medical or nursing records, or claims data (15–23, 26–28, 31). Some studies relied solely on interviews or clinician surveys (29–30); one study (25) assessed the use of laboratory tests or diagnostic tests.…”

The Role of Health Plans in Tobacco Control

“…Another HMO used a randomized controlled trial to test the effectiveness of different methods to enhance compliance with a smoking-cessation guideline. This study concluded that an intervention directed at clinic leaders resulted in more compliance than an intervention aimed at all clinic physicians (41).…”