Purpose:

The goal of this project is to develop and test the feasibility of methods to promote smoking cessation among the Medicaid-enrolled members of The Wellness Plan, a mixed model managed care organization founded in 1972 and serving a predominately African-American population in Detroit Michigan.

Objectives:

Specific project objectives include: (1) Assessment of the current smoking related behaviors and needs of The Wellness Plan (TWP) membership and providers, (2) to design, develop and test feasibility of system changes and smoking cessation interventions consistent with AHCPR guidelines, including organizational changes, provider support services and development and implementation of an electronic smoker identification system with both in-reach and outreach capacities and (3) evaluate the feasibility, pattern of use, initial effect upon smoker identification and referral, and costs associated with these system changes in preparation for submission of a full evaluation proposal to the RWJ Foundation.

Methodology:

These objectives will be met through a variety of data collection methods, system changes and analysis of interventions. Smoking related behaviors and needs of members will be assessed via a baseline telephone survey to ascertain smoking status, readiness to change, previous provider counseling and quit attempts. A provider questionnaire distributed to all staff model providers coupled with data from face-to-face key informant interviews will provide information concerning the cessation counseling behavior and needs of the providers. A chart review will document smoking status, provider counseling and co-morbidity. Exit interviews with randomly selected patients during the length of the study period will assist with documentation regarding provider counseling concerning cessation. The development and implementation of interventions will occur in two ways. First, organizational changes and provider support services will be addressed through creation of new policies, provider training, and the creation of a smokers resource center. Secondly, development and implementation of a smokers identification system which will utilize smoking as a “vital sign” captured on the encounter from by a medical assistant and another more general method. This method will employ telephone waiting time by playing a recorded message informing callers about smoking cessation and directing them to the smoker resource center. The periodic mailings to members will also include information about smoking cessation and the smoker resource center. Evaluation of the feasibility, patterns of use, initial effect upon smoker identification and referral, as well as costs associated with these system changes will take place in preparation for submission for a full evaluation proposal to the Robert Wood Johnson Foundation.