Targeting primary care referrals to smoking cessation clinics does not improve quit rates: implementing evidence-based interventions into practice.
OBJECTIVE
To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice.


METHODS
We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states.


METHODS
In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring. Control practices received mailed guidelines and VA audit-feedback reports as usual care.


METHODS
To represent the population of primary care-based smokers, we randomly sampled and screened 36,445 patients to identify and enroll eligible smokers at baseline (n=1,941) and follow-up at 12 months (n=1,080). We used computer-assisted telephone interviewing to collect smoking behavior, nicotine dependence, readiness to change, health status, and patient sociodemographics. We used practice surveys to measure structure and process changes, and administrative data to assess population utilization patterns.


RESULTS
Intervention practices adopted multifaceted EBQI plans, but had difficulty implementing them, ultimately focusing on smoking cessation clinic referral strategies. While attendance rates increased (p<.0001), we found no intervention effect on smoking cessation.


CONCLUSIONS
EBQI stimulated practices to increase smoking cessation clinic referrals and try other less evidence-based interventions that did not translate into improved quit rates at a population level.
VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda VA Ambulatory Care Center (152), 16111 Plummer Street, Sepulveda, CA 91343, USA.
Elizabeth M
EM
Yano
Lisa V
LV
Rubenstein
Melissa M
MM
Farmer
Bruce A
BA
Chernof
Brian S
BS
Mittman
Andrew B
AB
Lanto
Barbara F
BF
Simon
Martin L
ML
Lee
Scott E
SE
Sherman
D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D016540:Smoking Cessation / Q000379:methods*; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration