Connecting tobacco users in the primary care setting to comprehensive tobacco treatment: a quality improvement initiativ
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ORIGINAL ARTICLE
Connecting tobacco users in the primary care setting to comprehensive tobacco treatment: a quality improvement initiative Matthew S. Kendra 1
&
Jimmy Dang 2 & Maja Artandi 3 & Mytilee Vemuri 1
Received: 21 May 2020 / Accepted: 14 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The goal of the Stanford Tobacco Treatment Initiative was to improve referrals from primary care clinics to a specialty tobacco addiction treatment clinic. Methods Lean A3 problem solving was used to map current state, perform a cause and effect analysis, develop key drivers for program referrals, and ideate tests of change. We discarded ideas that put any additional burden on on-the-ground providers, favouring automated and sustainable processes. After prioritizing for feasibility and impact, plan-do-study-act (PDSA) cycles were performed on the following interventions: education and outreach, referral champions, and automated referrals. Results Following implementation, referrals to the specialty tobacco treatment clinic increased by 600% and had no impact on clinic provider workflow. Conclusion The new process spread through all of Stanford Primary Care clinics, has sustained over time, and could serve as a model for other institutions seeking to enhance capacity for tobacco treatment in their health care system using process improvement methodology. Keywords Tobacco treatment . Quality improvement . Primary care . Internal medicine . Population health
Introduction Tobacco use remains a leading cause of preventable death (US Department of Health and Human Services 2014). Due to time pressure and inadequate training, tobacco counseling in the primary care setting is limited in time and scope; and this produces relatively low quit rates — < 5% according to Silagy and Stead (2001). Research consistently shows that patients often need more than advice from their primary care provider in order to have a successful quit attempt (Williams
* Matthew S. Kendra [email protected] 1
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA
2
Stanford Health Care, Ambulatory Quality & Population Health, Stanford, CA, USA
3
Department of Primary Care and Population Health, Stanford University of School of Medicine, Stanford, CA, USA
et al. 2016). When tobacco users are treated with a comprehensive, specialty program using evidence-based combinations of behavior therapy and pharmacotherapy, long-term quit rates significantly increase and can reach 40–50% (Killen et al. 2008; Laude et al. 2017; Cinciripini et al. 2019). The Stanford Tobacco Cessation Program (STCP) was started in 2014 in the Department of Psychiatry and Behavioral Sciences. The STCP provides comprehensive outpatient tobacco treatment. The program consists of a 1-h intake with motivational interviewing, history gathering, psychiatric screening and referral, and carbon monoxide (CO) breath monitoring. After intake, patients join a weekly support
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