Lezli Redmond, MPH

Director Statewide Outreach Programs

Assistant Director, UW-CTRI

Disseminating Best Practices: Tobacco Dependence Treatment in Wisconsin

Wednesday, January 27, 2010

NIATx MeetingOrlando

Goals

Describe the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) and the Outreach Program

Describe our experience with the “how to” of disseminating best practices across a state

Discuss a national collaborative that serves as a learning community to support our work

Outline challenges and future plans

Advancing Tobacco Treatment Science at UW-CTRI

Established in 1992

Lead UW-Madison entity charged with reducing the harms from tobacco use

Research focuses on counseling, medications and health system changes to help smokers quit

$50 million in external grant funding over 15 years (primarily NIH)

Three SuccessiveNIH P50 Center Grants

1999-2004 Relapse: Linking Science

and Practice $10 million

2004-2009 Tobacco Dependence: Treatment and Outcomes $9 million

2009-2014 Engineering Effective Interventions for Tobacco Use: A Translational Laboratory $9 million

United States Public Health Service (PHS) Guidelines

• 1996 - Initial Guideline published

• Literature from 1975 -1995

• Approx. 3,000 articles

• 2000 - Revised Guideline published

• Literature from 1975 -1999• Approx. 6,000 articles

• 2008 - Updated Guideline published

• Literature from 1975 – 2007

• Approx. 8,700 total articles

UW-CTRI Cessation Outreach Programs

UW-CTRI Cessation Outreach Program 2000-2010

● Train primary care clinicians and other clinic staff

● Provide technical assistance on systems change to integrate evidence-based tobacco dependence treatment into healthcare delivery systems

● Reduce barriers to tobacco dependence treatment

● Increase insurance coverage for treatment

● Integrate the Wisconsin Tobacco Quit Line

Some Process Outcomes 2000-2010

• Trained over 10,000 clinicians and clinic staff

• Provided on-site training and technical assistance to 920 clinics and hospitals; 26 healthcare systems in Wisconsin

• Over 31,000 clinicians earned CME/CE

• The UW-CTRI website averages over 2,000,000 hits per year with over 2,000 unique visitors each week

• More than 150,000 callers to Wisconsin Tobacco Quit Line; 110,000 received treatment services (~15% of Wisconsin Smokers)

• Approximately 20% of callers referred by clinicians, 10,000 came in through Fax to Quit

• Integrated tobacco dependence treatment with EMRs at four health systems and several hospitals

• Insurance coverage for tobacco dependence treatment increased significantly

Long-term Outcomes

Increased quit attempts and decreased smoking rates– Smokers making serious quit attempts went

from 46% in 2003 to 59% in 2008. Nationally the rate stayed at approximately 45%.

– Between 2001 and 2007 adult tobacco use rates decreased from 24% to 19.7%.

Dissemination vs. Diffusion

Dissemination is active rather than passive

It’s a collaborative process

An organization must be “ready” and have the capacity to make the change

Involves formal and informal leaders at all levels of the organization

Active Dissemination Methods

Train the trainer

Media campaigns

Educating opinion leaders

Collaborative planning (take them where they’re at and work from there)

Encourage systems-level change implementation

Disseminating Innovations in Health Care

Find sound innovations Find and support “innovators” Invest in “early adopters” Trust and enable “reinvention” Make early adopter activity observable

Donald Berwick, MD, MPP 2003

Levers For Change

Partnerships (consistent messages; follow through; commitment; in it for the long haul)

Leadership (champions on all levels; tobacco dependence can be treated successfully; we will show you how; everyone can save money and do the right thing)

Innovations (be a leader; demonstrate success; HMOs competitive; connection with state-of-the art tobacco dependence treatment)

Finances (cost-saving, return on investment)

Tobacco Treatment is a Team Effort

UW-CTRI Outreach Lessons

1. Continue to make the “why” compelling and the “how” clear, do-able and tailored

2. “Spread” requires social interaction and constant, multi-faceted communications

3. Recognize, cultivate and celebrate champions and successful organizations

4. Use a systems approach

5. Demonstrate results and provide feedback

Why and How? for clinicians

It’s the most important thing you can do for the health of your patient

It will only take a few minutes of your time

It’s effective

We’ll show you and your colleagues how, and give you scripts for exactly what to say

Why and How? for Administrators

Per member per month (PMPM) cost for tobacco dependence treatment

$0.20 to $0.80 PMPM

America’s Health Insurance Plans (AHIP) and the Center for Health Research (CHR) demonstrated that investments in smoking cessation save money

It’s effective and evidence-based

We’ll provide valuable resources to help you do this (technical assistance and experience)

“Spread” Requires Social Interaction

Face-to-face best but not always possible

Supplement with website, email, distance learning, new technologies

Obtain communications expertise if possible

Present (or have successful innovators present) at conferences

“Spread” via Partnerships

Who could have a stake in the change?– Professional organizations– Quality improvement groups– Policy-makers – Coalitions– Provider groups and networks– Other networks, formal and informal– Client groups

Help Partners Tell Their Stories

Create or Join a Learning Community

Mission: Facilitate sustainable changes in health care systems to reduce tobacco use and prevalence

Methods: Share knowledge and practices, document emerging and best practices at the state level, work with national partners for national change

www.multistatecessationcollaborative.org

Use A Systems Approach

Typically, interventions target smokers or clinicians

Systems-level approaches implemented throughout the healthcare delivery system

Strategies ensure tobacco use is systematically addressed and treated at every clinical encounter, creating a new standard of care

Power of “institutionalizing” treatment of tobacco dependence

Systems Thinking

Small events can create large changes in complex systems

 

 

Why A Systems Approach?

Efforts directed only to tobacco users have been disappointing and expensive

Efforts directed only to healthcare providers not sufficient

Population-based is the key

We want to make BIG changes that are sustainable and integral

We can NOT create change alone

Results and Feedback

With a best practice you don’t need to “prove” effectiveness

Data is critical though often hard to collect Data can take you from “adoption” to full

implementation Quality improvement staff can help Feedback is powerful and can change individual

and organizational behavior

Challenges to UW-CTRI Outreach

Funding cuts to our program and overall tobacco control

Less ability to do face-to-face academic detailing

Loss of “champions”

Less political support (other priorities)

Sustainability

www.ctri.wisc.edu