title: The ONE step initiative: quality improvement in a pediatric clinic for secondhand smoke reduction.
abstract: OBJECTIVE
  Although comprehensive smoking counseling to limit secondhand smoke (SHS) is widely endorsed, it is often not done. Published evaluations of brief and practical systems that improve screening and counseling to reduce SHS are limited. Our objective was to determine if a quality improvement activity around smoking counseling leads to changes in (1) medical assistant and pediatric provider assessment of smoking history and (2) smoking or other behaviors affecting children's SHS exposure.
  
  
  METHODS
  In a large urban teaching clinic we assessed the ONE Step intervention, which included the following: (1) "Ask" (medical assistant asking whether caregivers smoke); (2) "Advise" (providers advising smoking outside and quitting if ready); (3) "Refer" (providers referring to the Colorado telephone QuitLine); and (4) electronic medical record prompts and required documentation regarding smoking. Medical assistant and provider assessments of smoking were evaluated with a chart review by using a pre-/posttest design. Caregiver behavior change was evaluated with a time-series survey that included assessment at baseline and follow-up via telephone at 6 and 12 months from study entry.
  
  
  RESULTS
  ONE Step was associated with a statistically significant increase in Ask, Advise, and Refer documentation. Caregiver surveys showed that 97% found discussions of SHS with providers acceptable. Six- and 12-month follow-ups, respectively, showed that 14% and 13% of smokers reported quitting and that 63% and 70% of current smokers reported reduced SHS exposure.
  
  
  CONCLUSIONS
  ONE Step was feasible to deliver in a busy outpatient setting, acceptable to families, and appears to have resulted in decreased exposure to SHS in our pediatric population.
authors.affiliation: Department of Pediatrics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA. maya.bunik@childrenscolorado.org
authors.forename: Maya
authors.initials: M
authors.lastname: Bunik
authors.forename: Keith L
authors.initials: KL
authors.lastname: Cavanaugh
authors.forename: Diane
authors.initials: D
authors.lastname: Herrick
authors.forename: Lauren
authors.initials: L
authors.lastname: Mehner
authors.forename: Janani
authors.initials: J
authors.lastname: Venugopalakrishnan
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Jini
authors.initials: J
authors.lastname: Puma
mesh_terms: D000328:Adult; D002648:Child; D003120:Colorado; D003299:Cooperative Behavior; D004282:Documentation / Q000592:standards; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic / Q000379:methods*; D010823:Physician Assistants; D015397:Program Evaluation; D058996:Quality Improvement; D012017:Referral and Consultation; D016540:Smoking Cessation / Q000379:methods*; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: parents/caregiver; pediatrics; quality improvement; secondhand smoke; smoking; smoking cessation