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HSR&D 2004 National Meeting Abstracts


1022. Does Reorganization of Smoking Cessation Care Improve Patient Quit Rates?
Elizabeth M Yano, PhD, MSPH, VA Greater Los Angeles HSR&D Center of Excellence and UCLA, AB Lanto, VA Greater Los Angeles HSR&D Center of Excellence, ML Lee, VA Greater Los Angeles HSR&D Center of Excellence and UCLA, LV Rubenstein, VA Greater Los Angeles HSR&D Center of Excellence and UCLA and RAND, SE Sherman, VA Greater Los Angeles HSR&D Center of Excellence and UCLA

Objectives: Adherence to smoking cessation guidelines requires practice changes at the patient, provider and system levels to achieve optimal quit rates. The objective of this study was to evaluate the effect of an expert-designed, locally adapted clinical reorganization of smoking cessation care on quit rates.

Methods: We evaluated the impact of an evidence-based quality improvement (QI) intervention using a group randomized trial in 18 VA primary care (PC) practices matched on size and academic affiliation. We randomly sampled and screened over 25,000 PC patients to identify, enroll and interview 1,941 smokers on their sociodemographics, health status, smoking behavior, attitudes and treatment experience, with 12-month follow-up interviews among 1,080 smokers. Imputing missing covariates with random hotdeck methods and weighting for enrollment and attrition losses, we performed logistic regression to evaluate intervention effects, controlling for patient-level predictors of quit attempts and quit status.

Results: Quit attempts increased among all patients. Adjusting for patient-level characteristics, we found no intervention effect on quit attempts or cessation. Higher addiction level (OR=0.81, 95% CI 0.74-0.88) and readiness-to-change (OR=2.52, 95% CI 1.97-3.21) were the only independent predictors of smoking cessation regardless of patient age, gender, race-ethnicity, marital status, education or intervention group (p<.0001).

Conclusions: Evidence-based QI did not lead to more quit attempts or cessation beyond national changes already underway through existing VA performance measurement and leadership incentives.

Impact: Significant barriers to restructuring care exist that are not responsive to local QI efforts.