This planning project tested an intervention implemented by one health maintenance organization to determine if obstetric providers could be incentivized to implement smoking cessation guidelines in their practices. The intervention consisted of training staff on smoking cessation counseling and paying the provider for each pregnant smoker counseled. The effectiveness of the intervention was measured by chart review and by telephone surveys of health plan members who gave birth prior to and after the intervention.

Eighteen practices (27 office sites), representing 80 physicians, participated in the study.
The chart review noted a statistically significant increase in identification of smoking status, but documentation of advice to quit declined. The same trend was documented in the telephone survey of patients who smoked. Only four claims for reimbursement were received by the health plan.

Overall, smoking cessation counseling worsened across the obstetric community that contracted with the health plan during the course of the study. Having multiple health plans work in partnership to ensure an adequate market share, or a more comprehensive systems approach to smoking cessation, may be required to be successful in this type of intervention.