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This planning project tested a quality improvement
initiative at Group Health Cooperative of Puget Sound using
a new automated billing system to record patient tobacco-use
status and provider intervention. To facilitate implementation,
provider performance feedback and senior-level financial incentives
were used.
Prior to the initiative in 1998, an average
of 1840 smokers per month were identified; this number increased
to 5101 in 1999 and 6348 in 2000. The number of smokers with
documented intervention also increased, from 1345 in November
1998 to 4002 in November 2000. These findings were statistically
significant (p < 0.0001) across the two-year study period
compared with 1998 data. The increase was not attributable
to an increase in the number of clinic visits over the study
period, as the number of visits remained stable or declined
slightly during the two-year study.
The automated system enabled timely creation
of performance reports (within 30 days of performance assessment)
as compared to six months if chart audit was used. The automated
system contained adequate data to provide feedback at the
provider level. The targets set for the senior level incentive
bonus were exceeded in both 1999 and 2000.
Using automated provider feedback and financial
incentives to increase compliance with a new system of tobacco
status identification and intervention was found to be feasible.
Other possible uses of this system, or a similar system, include
creation of tobacco registries and linking of a tobacco registry
with other disease-specific registries.
Citations:
McAfee T, Grossman R, Dacey S, McClure J. Capturing tobacco
status using an automated billing system: steps toward a tobacco
registry. Nicotine Tob Res 2002 Feb;4 Suppl 1:31-7.
Carlson CL, Chute P, Dacey S, McAfee TA.
Designing tobacco control systems and cessation benefits in
managed care: skill building workshop. Tob Control 2000;9
Suppl 1:I25-9.
For more information, contact:
Tim McAfee, M.D., M.P.H.
Center for Health Promotion
Group Health Cooperative of Puget Sound
12401 E. Marginal Way S.
Tukwila, WA 98168
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