Results

System level change to manage tobacco addiction: It’s not all “Doctor Work”

The environment has a substantive role in supporting a physician’s practice. For the management of tobacco addiction, a comprehensive evidence-based clinical system is key, including:

• Defined roles, with a designated “tobacco lead” and integration of team members
• Screening and assessment processes
• Prompting and charting systems
• Designated referral services and resources, and
• Education and performance feedback. 

For  TRaC II, Clinical Process Advisors (CPAs) have been facilitating improvement in tobacco dependence treatment at participating sites through a process of flow mapping with clinic team members. The following chart plots system changes for ten measures.  It compares the status at the CPA’s initial visit (i.e. pre-implementation) with the follow-up visit after flow mapping has occurred.  Significant differences were noted in eight out of the ten measures. (One further measure will be analyzed following completion of the project.)