The resources in this section describe the ways in which integrating tobacco use and treatment prompts into electronic health records (EHR) can ensure the systematic provision of the evidence-based practice of screening at every visit. These resources include examples of the successful integration of evidence-based tobacco dependence interventions into patient care using EHRs and detail how these efforts can help organizations meet meaningful use requirements.
Increases in Smoking Cessation Interventions After a Feedback and Improvement Initiative Using Electronic Health Records — 19 Community Health Centers, New York City, October 2010–March 2012 (2014) This resource describes the ways in which electronic health records (EHR) can facilitate tobacco dependence treatment. Over the study period, the patients documented as smokers increased 3% and those documented smokers who received tobacco dependence interventions increased over 30% in community health centers. Report from Centers for Disease Control and Prevention Integrating Tobacco Cessation Into Electronic Health Records This resource encourages the integration of prompts into electronic health records (EHR) to record smoking status. Additionally, it details meaningful use and provides a template of prompts that should be included. Factsheet with Template from American Academy of Family Physicians
The resources in this section provide overall guidance on best practices for the integration of tobacco dependence treatment into every patient visit and the current state of systems-level work to promote the universal provision of evidence-based cessation services within health care organizations. These resources summarize the Public Health Service (PHS) Clinical Practice Guidelines, Centers for Disease Control and Prevention (CDC) Best Practices, and other resources that can be applied to work across contexts to provide a background and a framework for strategies promoted by the Health Systems Change for a Tobacco-Free New York project. These resources can be referenced for orientation and educational purposes and used to guide the development of tools and resources for implementation.
ICD-10 Tobacco Billing Materials: Resource from CAI
Lessons Learned from Open Door Family Medical Center This resource outlines the success of Open Door in successfully integrating systems and policies to promote ongoing assessment of tobacco performance measures. Open Door has been able to implement tobacco dependence screening and treatment best practices into standard delivery of care. Case Study of Open Door Family Medical Center Planning & Implementing: Partnering with Population Health Improvement Program (PHIP) Contractors to Advance Mutual Goals This webinar discusses the New York State Population Health Improvement Program (PHIP), provides an overview of the role of the PHIP contractors, and identifies opportunities for collaboration between the Health Systems for a Tobacco-Free New York contractors and the PHIP contractors. Webinar from CAI Prescribing Tobacco Cessation Pharmacotherapy: Implementing Evidence-Based Practices This webinar highlights best practices for prescribing the seven FDA-approved tobacco cessation medications. Continuing medical education and continuing nursing education credits are available to participants at no charge. Webinar from CAI 2014 Health Center Profile (2014) This website provides information on the Federally Qualified Health Centers (FQHC) in New York State and nationwide. The FQHC profiles include indicators on tobacco use screening and tobacco cessation counseling for tobacco users. Interactive Website from Health Resources and Services Administration Best Practices for Comprehensive Control Programs (2014) This resource details best practice for comprehensive tobacco control programs, including defining the necessary components and funding recommendations. Best Practices from Centers for Disease Control and Prevention Healthcare Provider Reminder Systems, Provider Education, and Patient Education (2009) This guide provides an overview of the importance of promoting prevention and treatment of tobacco use followed by 17 action steps to educate and prompt providers to identify and intervene with patients who use tobacco in a sustainable way. Action Guide from Centers for Disease Control and Prevention & Partnership for Prevention Help Your Patients Quit Tobacco Use: An Implementation Guide for Community Health Centers (2013) This implementation guide includes background information about the burden of tobacco use. There are also case studies from Massachusetts, North Carolina, Oregon, and Utah included. Implementation Guide from Legacy and Partnership for Prevention Leading through Health System Change: A Public Health Opportunity (2013) This planning toolkit was designed to help providers understand changes associated with the Affordable Care Act and support them in leveraging current opportunities to promote health systems improvements. Toolkit from Georgia Health Policy Center at Georgia State University National Network of Public Health Institutes MassHealth Tobacco Cessation Benefit (2006) This webpage includes factsheets for clinical providers on pharmacology, and education on the Massachusetts Tobacco Cessation and Prevention Program for Medicaid recipients and other stakeholders. Factsheets from QUITWORKS Smoking Cessation Approaches for Primary Care (2005) This resource provides an example of a tobacco dependence treatment course with continuing medical education (CME) that can be taken for credit. Continuing Medical Education (CME) Course from Medscape State and County Indicators For Tracking Public Health Priority Areas (2012) This website provides indicators for tracking priority area progress by county across New York State. Interactive Website from New York State Department of Health Systems Change: Treating Tobacco Use and Dependence (2012) This resource provides a comprehensive summary of the Public Health Service (PHS) Clinical Practice Guidelines (2008 update), which recommend using systems change for treating tobacco use and dependence. Guidelines from Agency for Healthcare Research and Quality The Effect of Systematic Clinical Interventions with Cigarette Smokers on Quit Status and the Rates of Smoking-Related Primary Care Office Visits (2012) This article describes the practical application and evaluation of the 2008 update to the Public Health Service (PHS) Guidelines to Treating Tobacco Use and Dependence in Massachusetts. Findings indicate there was a decreased likelihood of office visits for smoking-related diagnoses for smokers following systems change. Please see Massachusetts Case Study below for more information. Article from PLOS ONE Tobacco Control: A Winnable Battle (2014) This resource defines tobacco control as a winnable battle using the World Health Organization's MPOWER model, while establishing the relationship between tobacco and chronic disease. This resource draws on CDC Best Practices for Comprehensive Tobacco Control Programs. Report from United States Department of Health and Human Services and Centers for Disease Control and Prevention Using Health Systems Change to Increase Tobacco Cessation: What Can State Tobacco Control Programs Do? Frequently Asked Questions (2014) This resource defines health systems, the meaning and importance of health systems change in the tobacco control context, and what health systems look like in practice with regards to delivery system design, clinical information systems and electronic health records (EHR), and decision support systems. FAQ from Centers for Disease Control and Prevention Adults who are Current Smokers by NYS County, 2013‐2014 (2015) This resource details the 2013-2014 Expanded Behavioral Risk Factor Surveillance System (eBRFSS) assessment, which estimates the number and percentages of adult smokers in New York State, both by county and statewide. Data from New York State Department of Health Help Your Patients Quit Smoking: A Coaching Guide (2013) This resource walks providers through how to administer the 5 A’s in the clinical setting, including guidance on working with patients who are not ready to quit, preparing to quit, dealing with smoking triggers, and dealing with and expecting to deal with withdrawal symptoms. Factsheet from New York City Department of Health and Mental Hygiene Treating Tobacco Use (2014) This online learning module, for which continuing medical education credits are available, explains the 5 A’s in tobacco dependence treatment, discusses the different FDA-approved medications and combined therapy, and explains coverage through New York State Medicaid. Online Learning Module from New York City Department of Health and Mental Hygiene Case Study: The Effect of Expanding Cessation Coverage–The Massachusetts Medicaid Cessation Benefit This case study illustrates how the provision of a comprehensive cessation benefit under Medicaid resulted in the increased utilization of tobacco cessation benefits by Medicaid enrollees in Massachusetts. Increased utilization of cessation benefits led to reduced smoking prevalence and hospitalizations among beneficiaries, and a return on investment. Case study from Centers for Disease Control and Prevention Addressing Tobacco Use Through Healthcare Systems: A Policy Brief (2013) This case study highlights the use of health systems to promote the standardized delivery of tobacco dependence treatment. Detailed within this case study are the positive outcomes garnered through addressing tobacco dependence in this way: reduced smoking, improved health, and return-on-investment. Policy Brief from Partnership for Prevention, Multi-State Collaborative for Health Systems Change, and Action to Quit Saving Money: The Massachusetts Tobacco Cessation Medicaid Benefit (2012) This document details the high burden of tobacco use, especially among Medicaid populations, and makes a case that implementing comprehensive tobacco cessation programs can save lives and money. Massachusetts’ Comprehensive Tobacco Cessation and Prevention Program is used to demonstrate successful implementation that garnered return-on-investment for both health care facilities and Medicaid plans. Policy Paper from Partnership for Prevention, George Washington University School of Public Health and Health Services, and Action to Quit The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts (2012) This resource details the return-on-investment achieved by taking a systems-level approach to addressing tobacco dependence among low-income populations, including Medicaid enrollees. Article from PLOS ONE A Patient-Centered Tobacco Cessation Workflow for Healthcare Clinics (2015) This report provides practical strategies for implementing agency and clinic tobacco cessation services. The workflow outlines needed staffing, as well as their roles and responsibilities. Report from Behavioral Health and Wellness Program University of Colorado Anschutz Medical Campus DIMENSIONS: Tobacco Free Toolkits (2013) This toolkit is designed for a broad range of healthcare providers, including direct providers, administrators, and healthcare organizations. The toolkit provides an education on tobacco use, skills for engaging in tobacco cessation discussions, efficient methods for assessing an individual’s readiness to quit, and information and research on treatments. Toolkit from Behavioral Health and Wellness Program University of Colorado Anschutz Medical Campus Tobacco use in the Workplace: A Model Policy (2013) This resource provides a framework for employers who are looking to establish and maintain a tobacco-free workplace. Information included includes benefits of a tobacco-free workplace, a model policy, definitions and procedure. Model Policy from American Cancer Society Prevention Agenda Towards the Healthiest State - Priority Area: Tobacco Use (2011) This resource outlines New York State’s Prevention Agenda’s objectives for preventing and reducing the burden of tobacco use and secondhand smoke to improve the health of New Yorkers. Resource from the New York State Department of Health Best Practices for Comprehensive Tobacco Control Programs (2014) This resource is an evidence-based guide to help states plan and establish effective tobacco control programs to prevent and reduce tobacco use. This document describes an integrated programmatic structure for implementing interventions proven to be effective and provides levels of state investment to prevent and reduce tobacco use in each state. Resource from Centers for Disease Control and Prevention Rx for Change: Clinician-Assisted Tobacco Cessation This series of webinars is a comprehensive tobacco cessation training program that equips health professional students and practicing clinicians, of all disciplines, with evidence-based knowledge and skills for assisting patients with quitting. Program draws heavily from the U.S. Public Health Service Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Webinars from the University of California, San Francisco The American Cancer Society Quit Tobacco and Smoking Tool Kit This toolkit provides information and messages to help employers assist their employees in quitting smoking. Resources will help raise awareness about the importance of not using tobacco and the steps employees can take to stay well, get well if they are facing cancer, fight back against the disease, and help the Society find cures. Toolkit from the American Cancer Society The resources in this section detail current policies and practices for enrollees in Medicaid and other third-party health insurance plans accessing tobacco use screening and interventions covered as preventive services under the Affordable Care Act. Resources identify challenges related to the implementation of this benefit and recommendations for improvement.
Barriers to Accessing Tobacco Cessation Treatment in Medicaid (2014) This resource documents the current state of Medicaid coverage for tobacco-dependence treatment, including a list of the challenges that Medicaid enrollees face by state in utilizing the smoking cessation benefit. Report from American Lung Association Medicaid Coverage and Utilization of Covered Tobacco-Cessation Treatments (2012) This article discusses the use of Medicaid coverage for tobacco dependence treatment in Arkansas. The authors suggest that low awareness and perceived ineffectiveness could be linked to lack of utilization of Medicaid benefits. Article from Robert Wood Johnson Foundation New York State Medicaid Managed Care (MMC) Pharmacy Benefit Information Center (2014) This website provides a function to look up whether drugs are covered by Medicaid Managed Care plans, which clinical providers can use to determine the tobacco dependence treatment options that will be covered for patients. Interactive Website from New York State Department of Health State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United States, 2008–2014 (2014) This resource describes the increased prevalence of tobacco use among Medicaid enrollees and outlines the need for consistent policies and comprehensive coverage of cessation treatments. Barriers to accessing treatments persist though many states have adopted policies to increase access since 2008. Report from Centers for Disease Control and Prevention Smoking Cessation Medication Prescribing Chart (2017) This prescribing chart details the different FDA-approved smoking cessation medications, including suggested regimen, precautions, contraindications, potential adverse effects, and brief instructions. Chart from New York City Department of Health and Mental Hygiene New York State (NYS) Smoking Cessation Counseling Information and Billing Codes (2015) This resource documents the billing codes for tobacco dependence treatment delivered to beneficiaries covered by New York State Medicaid, Medicare/Medicare Advantage, TRICARE, and commercial insurance. Guide from New York City Department of Health and Mental Hygiene The resources in this section provide an overview of the increased burden of smoking-related morbidity and mortality on populations with mental illness and severe mental illness. These resources can be used to stay current on research related to tobacco dependence and mental illness as well as to providing a background on tobacco dependence within this population.
Behavioral Health Tobacco Dependence Treatment Regulation Crosswalk This resource assists in developing a set of guidelines for behavioral health organizations to implement best practices in accordance with their regulations. It is intended to support New York State Department of Health Bureau of Tobacco Control Regional Contractors in examining regulations and standards of care that partnering behavioral health sites must adhere to. Resource from CAI
Decreasing Tobacco Use in Patients with Serious Mental Illness: Strategies for Implementing Best Practices in Mental Health Treatment Settings This webinar highlights best practices for implementing tobacco-free policies and integrating the delivery of evidence-based tobacco dependence treatment into care within health care settings serving individuals with serious mental illness. Webinar from CAI A Hidden Epidemic: Tobacco Use and Mental Illness (2011) This resource details the prevalence of tobacco use among those with mental illness, and identifies strategies for integrating dependence treatment into care at mental health facilities. This resource provides five case studies with lessons-learned. Report from from Legacy DIMENSIONS: Tobacco Free Toolkit for Healthcare Providers (2013) This toolkit details the relationship between tobacco use and health, especially among those with behavioral health conditions. Questions are raised regarding the timing of tobacco dependence treatment with this population and about tobacco dependence treatment and behavioral health conditions. Toolkit from Behavioral Health and Wellness Program University of Colorado Anschutz Medical Campus Smoking and Mental Health (2013) This UK-based resource addresses the burden of tobacco on those with mental illness. Delving into the consequences of tobacco use on individuals with stress, depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD), schizophrenia, Alzheimer’s disease and dementia, and post-traumatic stress disorder (PTSD), the authors reiterate policy recommendations of the Royal College of Physicians, which articulate the need for mental health service settings to be smoke-free and to prioritize the delivery of evidence-based cessation interventions. Factsheet from Action on Smoking and Health Vital Signs, Adult Smoking: Focusing on People with Mental Illness (2013) This resource provides detail on the increased burden of smoking on populations with mental illness, including statistics, information on the relationship between smoking and mental illness and opportunities to reach these populations. Factsheet from Centers for Disease Control and Prevention Literature Review: Emerging Practices for Tobacco Dependence Interventions and Treatments for Individuals with Serious Mental Illness (2015) This resource, developed by the COE for HSI, examines literature on emerging and best practices for tobacco dependence interventions and treatments for individuals with serious mental illness to inform the Health Systems for a Tobacco-Free New York project’s objective of decreasing the prevalence of tobacco use among this population. Article from CAI Literature Review Factsheet: Emerging Practices for Tobacco Dependence Interventions and Treatments for Individuals with Serious Mental Illness (2015) This resource, developed by the COE for HSI, summarizes the key findings of a literature review examining literature on emerging and best practices for tobacco dependence interventions and treatments for individuals with serious mental illness to inform the Health Systems for a Tobacco-Free New York project’s objective of decreasing the prevalence of tobacco use among this population. Factsheet from CAI Smoking Cessation for Persons with Mental Illnesses: A toolkit for Mental Health Providers (2009) This toolkit was developed for a broad continuum of mental health providers. Materials are intended for direct providers, as well as administrators and behavioral health organizations. Many of the materials are also appropriate for primary care and substance abuse providers. Toolkit from Behavioral Health and Wellness Program University of Colorado Anschutz Medical Campus Focus on Integrated Treatment (FIT) These online modules help programs implement integrated treatment for co-occurring mental health and substance use disorders, a proven strategy for helping people sustain and maintain recovery. Online modules focused on tobacco dependence treatment are included and emphasizes the importance of people setting their own recovery goals. Webinar from Center for Practice Innovations at Columbia Psychiatry New York State Clinical Records Initiative (NSYCRI) This resource is a standardized clinical record system designed for outpatient and residential, mental health, and substance use disorder treatment services. NYSCRI may be utilized in a paper (PDF), e-Word or Electronic Medical Record (EMR) format and is available in the public domain at no cost to users. All documentation data elements and processes were designed to accommodate and comply with the regulations and standards set by New York State Office of Mental Health and New York State Office of Alcoholism and Substance Abuse Services. Resource from the Office of Mental Health and the New York State Office of Alcoholism and Substance Abuse Services Office of Mental Health Patient Characteristics Survey The Patient Characteristics Survey (PCS) is conducted every two years, and collect demographics, clinical, and service-related information for each person who receives a public mental health service during a specified one-week period. The PCS receives data from approximately 5,000 mental health programs providing direct services to 175,000 people during the survey week. All programs licenses or funded by the NYS Office of Mental Health (OMH) are required to complete the survey. Resource from the Office of Mental Health