Use of systems change and health information technology to integrate comprehensive tobacco cessation services in a statewide system for delivery of healthcare

Abstract

<span style="font-family:Verdana;font-size:12px;">Despite the availability of effective treatments and recommendations for systems change, full application of the USPublic Health Service clinical practice guideline for the treatment of tobacco use is seldom achieved. The present report describes a comprehensive, structured approach used to implement the guideline and to integrate evidence-based cessation services into a system for delivery of health care. The PRECEDE-PROCEDE model and systems strategies were employed to design and implement the Tobacco Control Initiative (TCI), which provides evidence-based cessation services for the patients of a statewide public hospital system. For the TCI, multi-level assessments, pilot programs, electronic data collection, and performance feedback were needed to produce system-wide changes in workflow and in the quality of care for tobacco users. Although there are advances in health information technology (HIT), systems approaches are required for responding effectively to the Health Information Technology for Economic and Clinical Health (HI-TECH) Act and to standards governing use of electronic data related to treatment of tobacco use and dependence. </span

Do complexity-informed health interventions work? A scoping review

“… Horbar et al [ 30 ] Newborns received first dose of surfactant sooner compared to previous period (21 vs. 78 min post birth, p < 0.001). Kegler et al [ 25 ] More collaborative working practices Khan et al [ 31 ] Reduction in average brain function impediment score, drop from 19.21 to 14.75 MacKenzie et al [ 32 ] Turnaround time for beds reduced 210 to 54 min in 2004, maintained (2007) Moody-Thomas et al [ 33 , 34 ] Smoking quit rates increased from 5.0 % in 2008 to 9.6 % in 2009. Parchman et al [ 48 , 49 ], Noël et al [ 47 ] Significant and sustained improvement in ACIC scores for chronic care: from 5.58 to 6.33 to 6.60 (group 1) or 5.27 to 5.99 (group 2), both p < 0.05.…”

“…Without specific targets, some participants feared unstated institutional motives [ 42 ] or felt pointlessly imposed upon [ 34 ]. Other barriers to successful implementation were individuals’ resistance to change [ 24 , 33 , 34 , 41 , 44 , 47 ], reluctance by senior staff to yield to collaborative decision-making [ 24 , 27 , 47 ] and lack of financial incentives [ 47 ] or external facilitation [ 11 , 44 ]. Three articles provided especially detailed analyses of barriers to effective implementation [ 24 , 44 , 47 ].…”

The Head Start Tobacco Cessation Initiative: Using Systems Change to Support Staff Identification and Intervention for Tobacco Use in Low-Income Families

“…Once the four pilot sites were selected, Legacy and MSPH entered into collaboration with the Behavioral and Community Health Sciences Program of the LSUHSC School of Public Health. The experience of this group in initiating systems change in organizations serving high-risk populations was integral to the development of Initiative guidelines, which were designed to enable participating sites to incorporate cessation identification and referral protocols into their existing infrastructures [ 7 , 8 ]. This group developed protocols for implementing the Initiative and strategies for incorporating the Initiative into HS programs.…”

Partnering with Health Care Systems to Assess Tobacco Treatment Practices and Beliefs Among Clinicians: Evaluating the Process

“…Strategies addressed tobacco use treatment at the system, clinic, and patient levels (16). To monitor and improve provider adherence to Guideline recommendations, the TCI conducts patient surveys to assess their tobacco use, quit attempts, and perceptions of provider treatment (17), and electronic health record (EHR) queries to examine clinician practice patterns.…”