Smoking status identification: two managed care organizations' experiences with a pilot project to implement identification systems in independent practice associations.
OBJECTIVE
To determine whether managed care organizations (MCOs) can effectively promote the sustained use of smoking status identification systems among independent practice associations.


METHODS
Quasi-experimental design measuring smoking status documentation before and after an intervention.


METHODS
A chart review of the MCOs' patients at 4 participating primary care clinics determined the baseline for smoking status documentation before intervention. Baseline data were unavailable from a fifth participating clinic. Two quality improvement personnel were sent by the MCOs to help the clinics chose and implement a system for identifying smoking status. All of the clinics chose a sticker system. The change in smoking status documentation was assessed by chart reviews of patients enrolled in the MCOs who were seen during the period between 3 and 16 months after implementation of the system.


RESULTS
Following the intervention, a significant increase in smoking status documentation was noted among participating clinics. The proportion of patients whose smoking status was identified and documented by any method increased from 50% to 87% (P < .01) at the 4 clinics with baseline data. By clinic, the increase varied from 6% to 60%. The sticker system was the method by which most patients' smoking status was documented (77%). There were no controls, so the influence of outside factors, including a regional smoking cessation campaign that coincided with this study, cannot be quantified.


CONCLUSIONS
Managed care organizations may be an effective change agent for implementing the guidelines for tobacco use and dependence treatment.
Marcy
Theodore W
TW
National Cancer Institute, Division of Cancer Prevention, Office of Preventive Oncology, Rockville, MD, USA. theodore.marcy@uvm.edu
Thabault
Paulette
P
Olson
Jill
J
Tooze
Janet A
JA
Liberty
Barbara
B
Nolan
Sharon
S
D054598:Blue Cross Blue Shield Insurance Plans; D003376:Counseling / Q000706:statistics & numerical data*; D004282:Documentation / Q000592:standards*; D017598:Efficiency, Organizational; D017408:Guidelines as Topic; D006302:Health Services Research; D006801:Humans; D007193:Independent Practice Associations / Q000458:organization & administration*; D008329:Managed Care Programs / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D017010:Reminder Systems; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D014707:Vermont / Q000453:epidemiology