The Medi-Cal Incentives to Quit Smoking Project: Impact of Statewide Outreach Through Health Channels

Tong, Elisa K.; Stewart, Susan L.; Schillinger, Dean; Vijayaraghavan, Maya; Dove, Melanie S.; Epperson, Anna E.; Vela, Cynthia; Kratochvil, Susan; Anderson, Christopher M.; Kirby, Carrie; Safier, Jessica; Sloss, Gordon; Kohatsu, Neal D.

doi:10.1016/j.amepre.2018.07.031

Cited by 18 publications

(20 citation statements)

References 28 publications

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“…The statewide Medi-Cal Incentives To Quit Smoking project's statewide outreach through health channels was 2012 to 2015. 30 The UC quits project was a collaboration across all five University of California health systems in implementing bidirectional eReferrals during the study time period. 31,32 Reach During the study time period, 1,149 eReferrals were placed, reflecting 7.1% of 16,083 clinical encounters with a tobacco user.…”

Section: Results Implementationmentioning

confidence: 99%

“…12,26 We did not measure utilization of medications, which may improve quit rates, as these may not have been prescribed and documented in the EHR but used over the counter. There was also a concurrent Helpline offer for free nicotine patches mailed directly to patients in the Medi-Cal Incentives to Quit Smoking project (2012-2015) 30 which would also not have been documented in the EHR. We found that second eReferrals had a lower quit rate of 9.7% at 6 to 12 months.…”

Section: Discussionmentioning

confidence: 99%

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Health System Implementation of a Tobacco Quitline eReferral

et al. 2019

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Background Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on “real-world” implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden. Objectives This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system. Methods This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013–February 2016). Results Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking. Conclusion This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.

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Section: Results Implementationmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health System Implementation of a Tobacco Quitline eReferral

et al. 2019

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“…Per-caller costs for the all-household mailings were considerably lower than the $260 cost per call reported by the TIPs advertising campaign to generate calls to the national quitline. 24,25 As described in this issue by Tong et al, 19 during the MIQS project, there was a 70% increase in the average number of calls per year to the CSH from Medi-Cal members compared with periods prior to the MIQS project. MIQS outreach efforts originally sought to enroll 75,000 smokers and ended up engaging 92,900 Medi-Cal smokers.…”

Section: Medi-cal Incentives To Quit Smoking Outreach Strategiesmentioning

confidence: 96%

“…In this issue, Tong et al, 19 Vijayaraghavan and colleagues, 20 Saw et al, 21 and Dove and colleagues 22 describe various outreach strategies to low-income, American Indian, African American, Asian, Latino, white, and pregnant women/women with children populations and their impact on increasing calls to the CSH. As noted by Hood-Medland et al, 23 one of the most successful outreach methods leveraged existing "all-household" mailings to California's 14 million Medi-Cal members.…”

Section: Medi-cal Incentives To Quit Smoking Outreach Strategiesmentioning

confidence: 99%

Advancing Smoking Cessation in California's Medicaid Population

Roeseler

Kohatsu

2018

American Journal of Preventive Medicine

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“…However, the percentage of pregnant women who received counseling did not change and the percentage of nonpregnant women who received counseling decreased, which may have been because of the corresponding 70% increase in callers. 26 Overall, 13.6% of women who called the Helpline during the MIQS incentive period asked for the $20 financial incentive and this percentage did not differ substantially by pregnancy status, suggesting that promotion of the $20 gift cards reached both pregnant and nonpregnant women. The study also found that minority groups were more likely to ask for $20 indicating that MIQS reached a diverse population of women of reproductive age.…”

Section: Discussionmentioning

confidence: 92%

Medi-Cal Incentives to Quit Smoking Program: Reach to Pregnant and Parenting Women

Dove

Stewart²,

Cummins

et al. 2018

American Journal of Preventive Medicine

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Introduction: In California, half of pregnant women and children are on California's Medicaid (Medi-Cal). The MediCal Incentives to Quit Smoking program provided incentives to adults on MediCal to call the California Smokers Helpline (Helpline) from March 2012 to July 2015. This analysis examined reach of the MediCal Incentives to Quit Smoking program among pregnant and parenting women. Methods: This study examined caller data from the Helpline from 2010 to 2015 among women of reproductive age (18−45 years) enrolled in MediCal (n=32,691; analyzed in 2017/2018). The authors calculated the annual percentage of the target population reached who called the Helpline by pregnancy status and used adjusted prevalence ratios to examine the associations between MediCal Incentives to Quit Smoking incentive period, pregnancy/parenting status, MediCal Incentives to Quit Smoking incentives ($20 gift card and nicotine patch), and counseling. Results: Over the study period, the percentage of the target population reached increased for women of reproductive age (2.1% in 2011 to 3.0% in 2014) and pregnant women (2.1% in 2011 to 3.3% in 2014). The percentage of women who asked for the $20 gift card (13.6%) was not substantially different by pregnancy status, and WIC and nonprofits were important referral sources. Pregnant women were less likely to receive nicotine patches, but there was a 3-to 4-fold increase during the MediCal Incentives to Quit Smoking incentive period for both pregnant and nonpregnant women. Among nonpregnant women, counseling decreased 14% during the MediCal Incentives to Quit Smoking incentive period. Conclusions: Results suggest that the nicotine patch incentives motivated women to call the Helpline, even pregnant women who needed a physician's approval consistent with current American College of Obstetricians and Gynecologists cautions about the appropriateness of the patch during pregnancy. Supplement information: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

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The Medi-Cal Incentives to Quit Smoking Project: Impact of Statewide Outreach Through Health Channels

Abstract: Introduction:Little is known about how incentives may encourage low income smokers to call for quitline services. This study evaluates the impact of outreach through health channels on California Medicaid (Medi-Cal) quitline caller characteristics, trends, and reach.

Cited by 18 publications

References 28 publications

Health System Implementation of a Tobacco Quitline eReferral

Health System Implementation of a Tobacco Quitline eReferral

Advancing Smoking Cessation in California's Medicaid Population

Medi-Cal Incentives to Quit Smoking Program: Reach to Pregnant and Parenting Women

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