Implementation of evidence-based tobacco use cessation guidelines in managed care organizations.
BACKGROUND
Although managed care organizations (MCOs) may be optimal settings for implementing tobacco use cessation clinical guidelines, such guidelines remain poorly implemented in many MCO settings.


OBJECTIVE
We examined issues related to the implementation of guidelines in MCOs, to provide examples of studies that have addressed issues related to guideline implementation and to suggest ways behavioral medicine researchers can play a role in examining issues of how guidelines can be better implemented.


METHODS
Surveys of clinical guideline implementation, studies from the Robert Wood Johnson Foundation addressing tobacco use cessation in a managed care database, selected to illustrate issues related to system-wide implementation.


RESULTS
Surveys show that effective tobacco use cessation interventions remain underutilized in MCOs. A few studies have evaluated and shown the benefit of insurance coverage for tobacco use and dependence treatments, clinician reimbursement and leadership incentives, practice feedback, and leveraging administrative data to create tobacco use tracking systems. The studies also point to the need for large-scale, multidisciplinary, methodologically rigorous studies that allow one to isolate the effects of promising strategies as well as to explore synergistic effects as different system changes are combined.


CONCLUSIONS
Tobacco use cessation guidelines need to be better implemented in MCOs. Behavioral medicine research needs to move beyond treatment efficacy and effectiveness studies to focus on rigorous evaluations of these and other strategies to enhance guideline implementation and dissemination.
Taylor
C Barr
CB
Department of Psychiatry, Stanford University School of Medicine, CA, USA.
Curry
Susan J
SJ
D016208:Databases, Factual / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data