Purpose and Objectives:

The Allina Medical Group in Minneapolis, MN recognized that traditional provider education strategies including limited continuous quality improvement training are insufficient to decisively change providers’ smoking cessation practices and patient outcomes. It was concluded that clinics and their leaders must be motivated to achieve quality targets. In addition, the time-burden for providers of fully adhering to smoking cessation practice guidelines should be alleviated. Hence, the organization committed to implementing two organizational strategies to this effect. The two system changes consist of a) the formulation of performance expectations for smoking cessation practices and incentives for clinics and managers to reach care quality goals; and b) the inception of a centralized tobacco user registry and intervention system implementing the more time-consuming aspects of smoking cessation practice guidelines (Assist & Arrange) through proactive telephonic smoking cessation counseling.

Methodology:

A three-condition group randomized efficient (unbalanced) evaluation design will be implemented. The three experimental conditions are represented by I) no intervention/control, II) providing management/clinic site incentives, and III) providing management/clinic site incentives in addition to instituting a centralized smoker registry and registry-driven intervention system. Overall forty clinics will be randomly allocated. Fifteen clinics will be assigned to conditions I and II each with an additional ten clinics being assigned to condition III. The impact of these system changes on 1) practice patterns in clinics, 2) patient outcomes, 3) management, provider and patient experience with introduced system changes, and 4) cost will be evaluated. Clinic practice patterns will be measured in three rounds of cross-sectional patient pen-and pencil exit surveys. Tobacco use outcomes will be assessed through a telephone follow-up survey. Manager, provider and staff experience (satisfaction) with the newly introduced system changes will be assessed via provider/staff surveys and key informant interviews. Mixed model analysis of covariance will be performed with clinics serving as the unit of analysis.