Implement a Systematic Process to Deliver and Document a Brief Tobacco Cessation Intervention To All Clients Seeking Family Planning and Sexual Health Services in the Denver Metro Health Clinic

Summary

Impact Statement: 
Denver Health used rapid cycle improvement to implement a brief tobacco cessation intervention (2As &R) in a high risk urban family planning and sexual health clinic. The intervention was enhanced by modifications to the electronic medical record system. They plan to spread this intervention to all departments and clinics within DPH that provide client services.
Summary: 

Smoking rates in Denver have been slowly declining. Assistance such as physician advice, counseling, or nicotine replacement therapy (NRT) improves chances of quitting. Currently, those who enroll with the Colorado QuitLine receive 5 personalized coaching calls and 8 weeks of NRT at no cost.

Denver Metro Health Clinic (DMHC) operates under Denver Public Health (DPH), providing low-cost family planning and sexual health care to Denver adults and youths. The clinic population is at high risk for tobacco use; many are poor. The clinic currently uses an easily modifiable electronic medical record (EMR) system, making the clinic an ideal venue for the quality improvement (QI) initiative.

The specific aim was to implement and standardize a documented process to assess tobacco use, advise users to quit, and refer those who are ready to quit to cessation programs (Ask, Advise, Refer; 2As+R). The team used Plan, Do, Study, Act (PDSA) to implement the initiative. A team of clinic representatives, an informatics supervisor, and the QI coordinator defined current and ideal states and brainstormed potential barriers (and solutions) to implementation. Once they identified the ideal state, they modified the EMR to document steps of the 2As+R process.

Overall, the QI initiative was successful. Measuring change with subsequent steps was difficult; baseline data did not exist. However, 68% of tobacco users were advised to quit. Subsequent cycles revealed that clinicians required additional training for the Advise portion, and the choice set in the EMR was incomplete.

The QI team will keep monitoring outcomes and working with clinic staff to meet and maintain 100% for Ask and Advise. Long-range plans include implementation of 2As+R in all clinics/departments within DPH that provide client services. DPH and the QuitLine are developing an electronic referral system, so clinicians can refer clients to the QuitLine from the patient’s EMR.

Organization that conducted the QI initiative: 
DPH, DMHC
Citation: 

Mickiewicz, T. Public Health Quality Improvement Exchange. Implement a Systematic Process to Deliver and Document a Brief Tobacco Cessation Intervention To All Clients Seeking Family Planning and Sexual Health Services in the Denver Metro Health Clinic. Thu, 11/07/2013 - 15:22. Available at https://www.phqix.org/content/implement-systematic-process-deliver-and-document-brief-tobacco-cessation-intervention-all. Accessed June 30, 2015.

Submission Status: 
Completed
up
3 users have voted.

Comments

Submitted by abarna on

Thanks for sharing! I'm hoping this will help inform how we can reduce out maternal/pregnant smoking rates in our community.

up
0 users have voted.
Link to the resource where this submission is also published: 
No.