100,000 Quitters and Counting— Striving for a Tobacco-Free Generation


Renee Fogelberg, MD; Mariko Muzzio, MPH; Annida Brunato; Karin Dove, MPH; Debora Sawyer, MD; Christopher Lee, MHSA


Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Northern California

Background: Given the known morbidity and mortality of tobacco use, and the multiple touch points in our system, we can dramatically reduce usage rates with targeted intervention.
Methods: Northern California tobacco cessation work covers a population of more than 4 million members. In 2012, Kaiser Permanente Northern California had a tobacco-use prevalence of 9.4%. To address this known issue, we developed an intervention strategy to target any member with a documented history of active smoking or tobacco use. This strategy employed a multipronged approach:

  • Inreach—defining and codifying workflows to discuss quit options and resources with relevant patients during every visit with their primary care physician
  • Outreach—systematic engagement with relevant patients that highlights quit options and helpful resources in between visits
  • Strategic engagement—defining and codifying workflows to discuss quit options and tailored resources to relevant patients during “teachable moments” (pregnancy, inpatient admissions, perioperative discussions, etc).

Success of this multipronged strategy was measured through quit rates, medication-use rates, counseling rates, longer-term hospital readmissions, and perioperative complications.
Results: Within 7 years, our tobacco prevalence dropped from 9% to 7.4%; our medication-use rate increased from 3% to 7% (prescription fill rates); the number of smokers we counsel increased dramatically (telephonic coaching service); and perioperative quit rates approached 50%.
Discussion: Smokers represent a small subset of our members yet the associated immediate and long-term consequences owing to first- and second-degree exposure are significant. For those reasons, we chose to adopt an every-patient, every-visit approach, which included assessing and intervening with personalized cessation aids as appropriate. Ideally inreach and outreach approaches should be designed to identify at-risk populations. Workflows to support relapse prevention are also critical.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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