title: A Longitudinal Study of Medical Practices' Treatment of Patients Who Use Tobacco.
abstract: BACKGROUND
  Many patients who use tobacco have never been encouraged by their healthcare providers to quit. In recent years, incentives have been provided for medical practices to incorporate tobacco-cessation processes into routine care. This study examined growth in use of these processes as well as organizational and policy factors associated with their implementation.
  
  
  METHODS
  Data from three National Study of Physician Organizations surveys fielded in 2006-2013 were analyzed in 2014. The analyses estimated multivariate longitudinal and cross-sectional linear regression models to assess the relationship between implementation of cessation processes and change in practices' characteristics and external incentives, including state mandates for tobacco-cessation coverage.
  
  
  RESULTS
  Systematic identification of patients who use tobacco increased in large (26% to 91%, p<0.0001) and small-medium practices (69% to 83%, p<0.0001). Neither routine advice to quit nor referral to counseling and guideline-based point-of-care reminders increased. Practice feedback to physicians on their use of cessation interventions increased (18% to 29%, p<0.0001) for small-medium practices. State-mandated coverage was associated with the use of cessation processes in small-medium practices (p<0.0001), as was pay for performance participation (p<0.0001); public reporting (p<0.0001); Medicaid revenue (p=0.02); and practice size (p<0.0001). Among large practices, predictors were practice size (p<0.0001); hospital ownership (p=0.004); public reporting (p=0.03); and primary care practice (p=0.04).
  
  
  CONCLUSIONS
  The findings suggest that state-mandated coverage for tobacco-cessation treatment and increased use of external incentives such as pay for performance and public reporting programs may improve care for patients who use tobacco.
authors.affiliation: School of Public Health, University of California Berkeley, Berkeley, California. Electronic address: pramsay@berkeley.edu.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Ramsay
authors.affiliation: School of Public Health, University of California Berkeley, Berkeley, California.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
authors.affiliation: School of Public Health, University of California Berkeley, Berkeley, California.
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.affiliation: Department of Family and Community Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Diane R
authors.initials: DR
authors.lastname: Rittenhouse
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D015999:Multivariate Analysis; D010346:Patient Care Management; D010816:Physician Incentive Plans / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration; D012017:Referral and Consultation; D012052:Reimbursement, Incentive / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D064424:Tobacco Use / Q000628:therapy*; D020340:Tobacco Use Cessation / Q000191:economics*; D014481:United States