Does methodology affect the ability to monitor tobacco control activities? Implications for HEDIS and other performance measures

Harvard University, Cambridge, Massachusetts, United States
Preventive Medicine (Impact Factor: 2.93). 08/2003; 37(1):33-40. DOI: 10.1016/S0091-7435(03)00054-9
Source: PubMed

ABSTRACT It is unclear whether methodological differences in sample size, survey methods, and analysis approach significantly affect the ability to accurately monitor tobacco control activities and to make rate comparisons.
Questionnaires were sent to 64,764 members of nine health plans in diverse settings soon after their visit to a primary care clinician. Of these 41,677 completed responses were received. We compared responses received by mail and by telephone follow-up for the percentage of smokers, characteristics of smokers, and their rates of reporting physician cessation counseling.
Overall, 10.2% were current cigarette smokers, but the proportion was 8.6% for mail responders and 17.2% for phone follow-up responders. Smokers identified by phone follow-up were different from mail responders in most demographic and smoking characteristics and their reports of clinical smoking cessation activities differed for six of nine clinician smoking cessation actions. Calculating advice rates as a proportion of visits produced lower rates with more dispersion among plan rates than doing so without accounting for visit variation.
Smoking surveys using only mailed questionnaires dramatically undersample smokers, especially in some demographic groups. Comparisons of tobacco counseling among health plans can be improved by ensuring an adequate sample size and response rate and by analyzing by frequency of quit advice.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUNDSmoking remains the leading cause of preventable mortality in the US. The national clinical guideline recommends an intervention for tobacco use known as the 5-As (Ask, Advise, Assess, Assist, and Arrange). Little is known about the model’s effectiveness outside the research setting. OBJECTIVETo assess the effectiveness of tobacco treatments in HMOs. PARTICIPANTSSmokers identified from primary care visits in nine nonprofit health plans. DESIGN/METHODSSmokers were surveyed at baseline and at 12-month follow-up to assess smoking status and tobacco treatments offered by clinicians and used by smokers. RESULTSAnalyses include the 80% of respondents who reported having had a visit in the previous year with their clinician when they were smoking (n = 2,325). Smokers were more often offered Advice (77%) than the more effective Assist treatments–classes/counseling (41%) and pharmacotherapy (33%). One third of smokers reported using pharmacotherapy, but only 16% used classes or counseling. At follow-up, 8.9% were abstinent for >30days. Smokers who reported being offered pharmacotherapy were more likely to quit than those who did not (adjusted OR = 1.73, CI = 1.22–2.45). Compared with smokers who didn’t use classes/counseling or pharmacotherapy, those who did use these services were more likely to quit (adjusted OR = 1.82, CI = 1.16–2.86 and OR = 2.23, CI = 1.56–3.20, respectively). CONCLUSIONSSmokers were more likely to report quitting if they were offered cessation medications or if they used either medications or counseling. Results are similar to findings from clinical trials and highlight the need for clinicians and health plans to provide more than just advice to quit.
    Journal of General Internal Medicine 01/2009; 24(2):149-154. DOI:10.1007/s11606-008-0865-9 · 3.42 Impact Factor
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This report examines the experiences of five provider organizations in developing, testing, and implementing quality-of-care indicators, based on data collected from their electronic health record (EHR) systems. HealthPartners used the EHR to compile blood pressure measurements, Park Nicollet Health Services developed a composite measure for care of people with diabetes, Billings Clinic tested an automatic alert on potential interactions between antibiotics and the anticoagulant warfarin, Kaiser Permanente used a natural-language processing tool for counseling about tobacco use, and Geisinger Health System explored ways of reconciling Problem Lists and provider-visit notes regarding high-impact chronic-disease diagnoses. Common themes emerged from these case studies. They included challenges—of ensuring the validity and reliability of data, efficient workflow, and staff support—but the providers' successes in implementing their respective EHR-based quality measures demonstrated that such measures are adaptable to different EHR systems, amenable to improvement, and worth pursuing.