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Linking Peer and Neighborhood Based Smoking Cessation with Clinic Based
This evaluation grant was implemented at federally qualified health centers in the St. Louis, MO area serving a predominantly low-income, African American population. Multiple system changes were initiated, including requirement of documentation of smoking status and readiness to quit during clinical visits and development of neighborhood-based resources for cessation using evidence-based guidelines. This project used the Plan-Do-Study-Act (PDSA) approach to improving the impact and quality of change. This approach involves cycles of rapid improvements in which the multidisciplinary team followed the cycle of recognizing specific problems, studying changes to tackle the problems identified for a short period of time, assessing the outcome of these changes, and if needed initiating additional cycles of other changes. The impact of these system changes was measured by auditing the documentation rate of smoking status and readiness to quit as recorded on an encounter form by the physician and through patient exit interviews. Documentation rates increased from 2% to 94.3% within the 2 year program; a year after the project’s completion, rates remained over 90%. Exit interviews with patients were also conducted to assess the access to neighborhood-based smoking cessation resources and if their physician addressed smoking cessation in their clinical visit. The exit interview results for physicians’ addressing smoking mimicked the trend of documentation rates. These exit interviews also showed that the intervention clinics surpassed the comparison clinics in improvements in the awareness of neighborhood resources. Implementation of systems changes in this healthcare delivery system resulted in significant improvements in the rates of intervention with smokers. Citation: Fisher E, Musick J, Scott C, Miller JP, Gram R, Richardson V, Clark J, Pachalla V. Improving clinic- and neighborhood-based smoking cessation services within federally qualified health centers serving low-income, minority neighborhoods. Nicotine Tob Res 2005; 7(Suppl 1): S45-S56. For more information, contact: Edwin B. Fisher, PhD |
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