Assessing the structure of smoking cessation care in the Veterans Health Administration.
OBJECTIVE
National smoking cessation practice guidelines offer recommendations regarding the processes and structure of care. Facilities routinely measure the processes of care but not the structure of care. This pilot study assessed the structure of smoking cessation care at Veterans Health Administration facilities.


METHODS
Key informants at 18 sites completed a brief checklist survey adapted from national smoking cessation guidelines. Responses were compared with detailed site surveys.


RESULTS
Guideline adherence was seen in identifying smokers and treating inpatient smokers. Areas of low adherence include offering incentives and defining staff responsibilities. The checklist survey showed poor correspondence with the detailed survey, with low agreement on systematic screening (kappa = .21) and higher agreement on primary care prescribing authority (kappa = .53).


CONCLUSIONS
This pilot survey provides a potential rapid method for assessing adherence to systems recommendations from the national smoking cessation guidelines. The relatively low agreement with a more detailed survey suggests that the two surveys may have been measuring different aspects of smoking cessation care.
Sherman
Scott E
SE
Veterans Administration Health Services Research and Development Center of Excellence for the Study of Healthcare Provider Behavior, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, California 91343, USA. ssherman@ucla.edu
Yano
Elizabeth M
EM
York
Laura S
LS
Lanto
Andy B
AB
Chernof
Bruce A
BA
Mittman
Brian S
BS
D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006284:Health Plan Implementation; D006787:Hospitals, Veterans / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000592:standards