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Khan A, Green K, Medlin L, Khandaker G, Lawler S, Gartner C. Impact of the '10,000 lives' program on Quitline referrals, use and outcomes by demography and Indigenous status. Drug Alcohol Rev 2022; 41:1499-1509. [PMID: 35830355 PMCID: PMC9796440 DOI: 10.1111/dar.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/12/2022] [Accepted: 05/04/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In November 2017, Central Queensland Public Health Unit launched the '10,000 Lives' initiative to reduce smoking prevalence in Central Queensland. The program partnered with local champions and other programs (e.g. 'Deadly Choices') to promote the use of smoking cessation services (e.g. Quitline) in Central Queensland. This study assesses the program's impact on Quitline use by participant demographics and Indigenous status. METHODS We compared the number of referred individuals who participated in and completed the Quitline program, and quit smoking during 26-months before (July 2015 to August 2017) and after (November 2017 to December 2019) the '10,000 Lives' launch. We conducted an interrupted time series analysis of monthly referrals to and use of Quitline for Aboriginal and Torres Strait Islander peoples. RESULTS Overall, 3207 individuals were referred to Quitline during the 26-months-post-launch compared to 1594 during 26-months-pre-launch period of '10,000 Lives'. The number of referred individuals who completed Quitline program increased by 330.7% and quit smoking by 308.3% in post-launch period. The increase was substantially higher among aged 45+ years, females and Aboriginal and Torres Strait Islander peoples. The result for referrals and use of Quitline was validated by interrupted time series analysis for Aboriginal and Torres Strait Islander peoples. DISCUSSION AND CONCLUSIONS The '10,000 Lives' collaborative approach to partner with local champions and targeted smoking cessation programs was effective in increasing the use of Quitline and smoking cessation among all demographic groups, including Aboriginal and Torres Strait Islander peoples. This approach can be used in other regions to address higher smoking prevalence.
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Affiliation(s)
- Arifuzzaman Khan
- School of Public HealthThe University of QueenslandBrisbaneAustralia,Central Queensland Public Health UnitCentral Queensland Hospital and Health ServiceRockhamptonAustralia
| | - Kalie Green
- Central Queensland Public Health UnitCentral Queensland Hospital and Health ServiceRockhamptonAustralia
| | - Linda Medlin
- Aboriginal and Torres Strait Islander Health and WellbeingCentral Queensland Hospital and Health ServiceRockhamptonAustralia
| | - Gulam Khandaker
- School of Public HealthThe University of QueenslandBrisbaneAustralia,Central Queensland Public Health UnitCentral Queensland Hospital and Health ServiceRockhamptonAustralia
| | - Sheleigh Lawler
- School of Public HealthThe University of QueenslandBrisbaneAustralia
| | - Coral Gartner
- School of Public HealthThe University of QueenslandBrisbaneAustralia
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Valencia CV, Dove MS, Cummins SE, Kirby C, Zhu SH, Giboney P, Yee HF, Tu SP, Tong EK. A Proactive Outreach Strategy Using a Local Area Code to Refer Unassisted Smokers in a Safety Net Health System to a Quitline: A Pragmatic Randomized Trial. Nicotine Tob Res 2022; 25:43-49. [PMID: 36103393 PMCID: PMC9717369 DOI: 10.1093/ntr/ntac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/07/2022] [Accepted: 07/01/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Proactive outreach offering tobacco treatment is a promising strategy outside of clinical settings, but little is known about factors for engagement. The study objective is to examine the impact of caller area code in a proactive, phone-based outreach strategy on consenting low-income smokers to a quitline e-referral. AIMS AND METHODS This pragmatic randomized trial included unassisted adult smokers (n = 685), whose preferred language was English or Spanish, in a Los Angeles safety-net health system. Patients were randomized to receive a call from a local or generic toll-free area code. Log-binomial regression was used to examine the association between area code and consent to a quitline e-referral, adjusted for age, gender, language, and year. RESULTS Overall, 52.1% of the patients were contacted and, among those contacted, 30% consented to a referral. The contact rate was higher for the local versus generic area code, although not statistically significant (55.6% vs. 48.7%, p = .07). The consent rate was higher in the local versus generic area code group (adjusted prevalence ratio 1.29, 95% CI 1.01-1.65) and also higher for patients under 61 years old than over (adjusted prevalence ratio 1.47, 95% CI 1.07-2.01), and Spanish-speaking than English-speaking patients (adjusted prevalence ratio 1.40, 95% CI 1.05-1.86). CONCLUSIONS Proactive phone-based outreach to unassisted smokers in a safety net health system increased consent to a quitline referral when local (vs. generic) area codes were used to contact patients. While contact rate did not differ by area code, proactive phone-based outreach was effective for engaging younger and Spanish-speaking smokers. IMPLICATIONS Population-based proactive phone-based outreach from a caller with a local area code to unassisted smokers in a safety net health system increases consent to an e-referral for quitline services. Findings suggest that a proactive phone-based outreach, a population-based strategy, is an effective strategy to build on the visit-based model and offer services to tobacco users, regardless of the motivational levels to quit.
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Affiliation(s)
- Cindy V Valencia
- Corresponding Author: Cindy V. Valencia, PhD, Center for Healthcare Policy and Research, University of California, Davis, 4900 Broadway Ave., Suite 1430, Sacramento, CA 95820, USA. Telephone: 916-734-0136; E-mail:
| | - Melanie S Dove
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Sharon E Cummins
- Department of Family Medicine and Public Health, Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Carrie Kirby
- Department of Family Medicine and Public Health, Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Paul Giboney
- Los Angeles County Department of Health Services, Los Angeles County in Los Angeles, CA, USA
| | - Hal F Yee
- Los Angeles County Department of Health Services, Los Angeles County in Los Angeles, CA, USA
| | - Shin-Ping Tu
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Elisa K Tong
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
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Valencia CV, Dove M, Tong EK. Factors Associated With Receipt of Smoking Cessation Advice and Assistance by Health Professionals Among Latino and Non-Latino White Smokers With Medicaid Insurance in California. JAMA Netw Open 2022; 5:e2144207. [PMID: 35044467 PMCID: PMC8771292 DOI: 10.1001/jamanetworkopen.2021.44207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Nationally, Latino smokers are less likely than non-Latino White smokers to receive advice and assistance from health professionals to quit smoking. California's Medicaid expansion included the Patient Protection and Affordable Care Act's comprehensive tobacco cessation benefits; however, it is unknown whether expanded coverage helped resolve this disparity. OBJECTIVE To examine the association between race and ethnicity (Latino and non-Latino White) and health professional cessation advice and assistance among smokers with Medi-Cal insurance in the post-Affordable Care Act period. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study was conducted with the 2014 and 2016-2018 California Health Interview Survey. A total of 1861 Latino and non-Latino White current smokers aged 18 to 64 years who had Medi-Cal insurance and consulted a health professional in the past 12 months were included. Data were analyzed between December 1, 2019, and April 30, 2021. EXPOSURE Race and ethnicity classified as Latino or non-Latino White. MAIN OUTCOMES AND MEASURES The outcomes were receipt of health professional advice to quit smoking or assistance to quit in the past 12 months. Logistic regression was used to examine the association between race and ethnicity and each outcome, adjusted for sociodemographic factors, smoking behavior, health care factors, and acculturation measures. All estimates were weighted to adjust for the complex survey design. RESULTS Among 1861 participants, 44.8% were Latino, 53.8% were aged 40 years or older (mean [SE], 39.7 [0.79] years), 54.1% were male, and 59.9% had less than a high school education. Latino smokers were less likely than non-Latino White smokers to receive health professional advice (38.3% Latino smokers vs 55.3% non-Latino White smokers) or assistance (21.8% Latino smokers vs 35.7% non-Latino White smokers). In the unadjusted model, compared with non-Latino White smokers, Latino smokers were less likely to receive advice (odds ratio [OR], 0.50; 95% CI, 0.29-0.86) and also less likely to receive assistance (OR, 0.50; 95% CI, 0.25-1.00). However, in the adjusted model, race was no longer significant. Smokers with more office visits (adjusted OR, 2.44; 95% CI, 1.61-3.70) and those with at least 1 chronic disease (adjusted OR, 1.99; 95% CI, 1.15-3.43) were more likely to receive advice from a health professional. Additionally, daily smokers compared with nondaily smokers (adjusted OR, 2.29; 95% CI, 1.03-5.13) were more likely to receive assistance. CONCLUSIONS AND RELEVANCE In this cross-sectional study, more office visits, having a chronic disease, and daily smoking were associated with an increased likelihood of receiving smoking cessation advice or assistance. Use of strategies to engage tobacco users outside of the clinic, such as proactive outreach and community-based engagement, may help address this disparity.
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Affiliation(s)
- Cindy V. Valencia
- Department of Internal Medicine, University of California, Davis, Sacramento
| | - Melanie Dove
- Department of Public Health Sciences, University of California, Davis, Davis
| | - Elisa K. Tong
- Department of Internal Medicine, University of California, Davis, Sacramento
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Economou MA, Kaiser BN, Yoeun SW, Crable EL, McMenamin SB. Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221096289. [PMID: 37091072 PMCID: PMC9924244 DOI: 10.1177/26334895221096289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In 2016, the California Department of Healthcare Services (DHCS) released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage among Medicaid beneficiaries. However, implementation remains poor. We apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify barriers and facilitators to fidelity to APL 16-014 across California Medicaid MCPs. Methods We assessed fidelity through semi-structured interviews with MCP health educators (N = 24). Interviews were recorded, transcribed, and reviewed to develop initial themes regarding barriers and facilitators to implementation. Initial thematic summaries were discussed and mapped onto EPIS constructs. Results The APL (Innovation) was described as lacking clarity and specificity in its guidelines, hindering implementation. Related to the Inner Context, MCPs described the APL as beyond the scope of their resources, pointing to their own lack of educational materials, human resources, and poor technological infrastructure as implementation barriers. In the Outer Context, MCPs identified a lack of incentives for providers and beneficiaries to offer and participate in tobacco-cessation programs, respectively. A lack of communication, educational materials, and training resources between the state and MCPs (missing Bridging Factors) were barriers to preventing MCPs from identifying smoking rates or gauging success of tobacco-cessation efforts. Facilitators included several MCPs collaborating with each other and using external resources to promote tobacco cessation. Additionally, a few MCPs used fidelity monitoring staff as Bridging Factors to facilitate provider training, track providers' identification of smokers, and follow-up with beneficiaries participating in tobacco-cessation programs. Conclusions The release of the evidence-based APL 16-014 by California's DHCS was an important step forward in promoting tobacco-cessation services for Medicaid MCP beneficiaries. Improved communication on implementation in different environments and improved Bridging Factors such as incentives for providers and patients are needed to fully realize policy goals. Plan Language Summary In 2016, the California Department of Healthcare Services (DHCS) in California released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage to address tobacco use among Medicaid beneficiaries. We conducted semi-structured interviews with health educators in California Medicaid MCPs to explore the barriers and facilitators to implementing the APL using the Exploration, Preparation, Implementation, Sustainment framework. According to MCPs, barriers included a lack of clarity in the APL guidelines; a lack of resources, including educational materials, infrastructure to identify smokers, and human resources; and a lack of incentives or penalties for providers to provide tobacco-cessation materials to beneficiaries. Facilitators included collaboration between MCPs and state and/or national public health programs. Overall, our findings can provide avenues for improving the implementation of tobacco-cessation services within Medicaid MCPs.
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Affiliation(s)
- Melina A. Economou
- Department of Anthropology, University of California, San Diego, CA,
USA
| | - Bonnie N. Kaiser
- Department of Anthropology, University of California, San Diego, CA,
USA
- Global Health Program, University of California, San Diego, CA,
USA
- UC San Diego ACTRI Dissemination and
Implementation Science Center, San Diego, CA, USA
| | - Sara W. Yoeun
- Herbert Wertheim School of Public Health, University of California,
San Diego, CA, USA
| | - Erika L. Crable
- UC San Diego ACTRI Dissemination and
Implementation Science Center, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA,
USA
| | - Sara B. McMenamin
- Herbert Wertheim School of Public Health, University of California,
San Diego, CA, USA
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Abstract
The impact of tobacco smoking treatment is determined by its reach into the smoking population and the effectiveness of its interventions. This review evaluates the reach and effectiveness of pharmacotherapy and psychosocial interventions for smoking. Historically, the reach of smoking treatment has been low, and therefore its impact has been limited, but new reach strategies such as digital interventions and health care system changes offer great promise. Pharmacotherapy tends to be more effective than psychosocial intervention when used clinically, and newer pharmacotherapy strategies hold great promise of further enhancing effectiveness. However, new approaches are needed to advance psychosocial interventions; progress has stagnated because research and dissemination efforts have focused too narrowly on skill training despite evidence that its core content may be inconsequential and the fact that its mechanisms are either unknown or inconsistent with supporting theory. Identifying effective psychosocial content and its mechanisms of action could greatly enhance the effectiveness of counseling, digital, and web interventions.
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Affiliation(s)
- Timothy B Baker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
| | - Danielle E McCarthy
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
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Weng X, Wang MP, Li HCW, Cheung YTD, Lau CY, Kwong ACS, Lai VWY, Chan SSC, Lam TH. Effects of active referral combined with a small financial incentive on smoking cessation: study protocol for a cluster randomised controlled trial. BMJ Open 2020; 10:e038351. [PMID: 33109654 PMCID: PMC7592296 DOI: 10.1136/bmjopen-2020-038351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Evidence-based smoking cessation treatments are effective but underutilised, accentuating the need for novel approaches to increase use. This trial investigates the effects of active referral combined with a financial incentive to use smoking cessation services on smoking abstinence among community smokers. METHODS AND ANALYSIS This ongoing study is a two-arm, assessor-blinded, pragmatic, cluster randomised controlled trial with follow-ups at 1, 2, 3 and 6 months after randomisation. We aim to enrol 1134 daily smokers from 70 community sites (clusters) in Hong Kong. All participants receive Ask, Warn, Advise, Refer, Do-it-again (AWARD) guided advice and a self-help booklet at baseline. Additionally, participants in the intervention group receive an offer of referral to smoking cessation services at baseline and a small financial incentive (HK$300≈US$38) contingent on using any of such services within 3 months. The primary outcomes are bioverified abstinence (exhaled carbon monoxide <4 ppm and salivary cotinine <10 ng/mL) at 3 and 6 months. Secondary outcomes include self-reported 7-day point prevalence of abstinence, smoking reduction rate, quit attempts and the use of smoking cessation services at 3 and 6 months. Intention-to-treat approach and regression models will be used in primary analyses. ETHICS AND DISSEMINATION This protocol has been approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 18-318). The results of this trial will be submitted for publication in peer-reviewed journals, and the key findings will be presented at national and international conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry NCT03565796.
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Affiliation(s)
- Xue Weng
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | | | | | - Ching Yin Lau
- School of Nursing, University of Hong Kong, Hong Kong, China
| | | | | | | | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
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Parks MJ, Hughes KD, Keller PA, Lachter RB, Kingsbury JH, Nelson CL, Slater JS. Financial incentives and proactive calling for reducing barriers to tobacco treatment among socioeconomically disadvantaged women: A factorial randomized trial. Prev Med 2019; 129:105867. [PMID: 31634512 DOI: 10.1016/j.ypmed.2019.105867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/13/2019] [Accepted: 10/11/2019] [Indexed: 11/23/2022]
Abstract
Improved strategies and scalable interventions to engage low-socioeconomic status (SES) smokers in tobacco treatment are needed. We tested an intervention designed to connect low-SES smokers to treatment services, implemented through Minnesota's National Breast and Cervical Cancer Early Detection Program (Sage) in 2017; the trial was designed to last 3 months (July through October). Participants were female smokers who were 250% below the federal poverty level (randomized N = 3723; analyzed N = 3365). Using a factorial design, participants were randomized to six intervention groups consisting of a proactive call (no call vs call) and/or a financial incentive offered for being connected to treatment services ($0 vs $10 vs $20). Simple randomization was conducted using Stata v.13. All individuals received direct mail. Participants and staff were blinded to allocation. The outcome was connection via phone to QUITPLAN Services®, Minnesota's population-based cessation services. Groups that received $10 or $20 incentives had higher odds of treatment engagement compared to the no incentive group [respectively, OR = 1.94; 95% CI (1.19-3.14); OR = 2.18; 95% CI (1.36-3.51)]. Individuals that received proactive calls had higher odds of treatment engagement compared to individuals not called [OR = 1.59; 95% CI (1.11-2.29)]. Economic evaluation revealed that the $10 incentive, no call group had the best cost-benefit ratio compared to the no incentive, no call group. Direct mail with moderate incentives or proactive calling can successfully encourage connections to population-based tobacco treatment services among low-SES smokers. The intervention could be disseminated to similar programs serving low-SES populations. This trial is registered at ClinicalTrials.gov (NCT03760107).
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Affiliation(s)
- Michael J Parks
- University of Minnesota, 1100 S. Washington Ave., Minneapolis, MN 55415, USA; Minnesota Department of Health, 85 East 7th Place, St. Paul, MN 55164, USA.
| | - Kelly D Hughes
- Minnesota Department of Health, 85 East 7th Place, St. Paul, MN 55164, USA
| | - Paula A Keller
- ClearWay Minnesota(SM), 8011 34th Ave S, Suite 400, Minneapolis, MN 55425, USA
| | - Randi B Lachter
- ClearWay Minnesota(SM), 8011 34th Ave S, Suite 400, Minneapolis, MN 55425, USA
| | - John H Kingsbury
- Minnesota Department of Health, 85 East 7th Place, St. Paul, MN 55164, USA
| | - Christina L Nelson
- Minnesota Department of Health, 85 East 7th Place, St. Paul, MN 55164, USA
| | - Jonathan S Slater
- Minnesota Department of Health, 85 East 7th Place, St. Paul, MN 55164, USA
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Hood-Medland EA, Stewart SL, Nguyen H, Avdalovic M, MacDonald S, Zhu SH, Mayoral A, Tong EK. Health System Implementation of a Tobacco Quitline eReferral. Appl Clin Inform 2019; 10:735-742. [PMID: 31578046 PMCID: PMC6774758 DOI: 10.1055/s-0039-1697593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on "real-world" implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden. OBJECTIVES This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system. METHODS This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013-February 2016). RESULTS Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking. CONCLUSION This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.
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Affiliation(s)
- Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California, Davis in Sacramento, California, United States
| | - Susan L. Stewart
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis in Sacramento, California, United States
| | - Hien Nguyen
- Department of Internal Medicine, University of California, Davis in Sacramento, California, United States
| | - Mark Avdalovic
- Department of Internal Medicine, University of California, Davis in Sacramento, California, United States
| | - Scott MacDonald
- Department of Clinical Informatics, University of California, Davis in Sacramento, California, United States
| | - Shu-Hong Zhu
- Department of Family Medicine, Moores Cancer Center, University of California, San Diego in San Diego, California, United States
| | - Antonio Mayoral
- Department of Family Medicine, Moores Cancer Center, University of California, San Diego in San Diego, California, United States
| | - Elisa K. Tong
- Department of Internal Medicine, University of California, Davis in Sacramento, California, United States
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Backman DR, Kohatsu ND, Stewart OT, Barrington RL, Kizer KW. A Quality Strategy to Advance the Triple Aim in California's Medicaid Program. Am J Med Qual 2019; 35:213-221. [PMID: 31272192 DOI: 10.1177/1062860619860251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The California Department of Health Care Services (DHCS) administers the nation's largest Medicaid program. In 2012, DHCS developed a Quality Strategy modeled after the National Quality Strategy to guide the Department's activities aimed at advancing the Triple Aim. The Triple Aim seeks to improve the patient experience of care and the health of populations as well as reduce the per capita cost of health care. An academic team was contracted to assist DHCS in developing the strategy, which also was informed by extensive stakeholder input, an advisory committee, and a comprehensive inventory of DHCS quality improvement (QI) activities. From 2012 to 2018, the strategy included 129 unique QI activities. Most activities were intended to deliver more effective, efficient, affordable care or to advance disease prevention. This qualitative assessment of the DHCS Quality Strategy provides insights that may inform other Medicaid programs or large health systems as they develop quality strategies.
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Affiliation(s)
| | - Neal D Kohatsu
- California Department of Health Care Services, Sacramento, CA.,Kohatsu Consulting, Sacramento, CA
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Zhu SH, Anderson CM, Wong S, Kohatsu ND. The Growing Proportion of Smokers in Medicaid and Implications for Public Policy. Am J Prev Med 2018; 55:S130-S137. [PMID: 30454667 DOI: 10.1016/j.amepre.2018.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/10/2018] [Accepted: 07/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION This study examined survey data from before and after California expanded its Medicaid program under the Affordable Care Act. It assessed changes in the insurance status of smokers, the proportion of smokers in Medicaid, and the health and well-being of those smokers relative to their counterparts in other insurance groups. METHODS The study compared two data sets from the California Health Interview Study, the 2011-2012 (N=42,935) and 2016 (N=21,055) surveys. Measures include health insurance status, smoking status, chronic health conditions, frequency of doctors' visits, and psychological distress. Data were analyzed in 2018. RESULTS From 2011-2012 to 2016, the estimated number of California smokers in Medicaid nearly doubled from 738,113 to 1,447,945, and the proportion of smokers covered by Medicaid increased from 19.3% to 41.5%. Compared with those with private insurance, smokers in Medicaid were more likely to have chronic disease, have made five or more doctors' visits in the past year, and be in severe psychological distress. In 2016, a total of 51.4% of all adult smokers with chronic disease conditions and 57.8% of those in severe psychological distress were covered by Medicaid. CONCLUSIONS With Medicaid covering a much higher proportion of smokers, especially of those smokers with chronic disease and in psychological distress, state Medicaid programs and plans must make tobacco cessation a top priority. They should encourage clinicians to ask, advise, and assist all smokers, track progress in reducing smoking prevalence, employ mass communication strategies to drive quit attempts, improve access to medications, and develop or expand programs to help smokers quit. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Affiliation(s)
- Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Moores Cancer Center, University of California, San Diego, La Jolla, California.
| | | | - Shiushing Wong
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Neal D Kohatsu
- Kohatsu Consulting, Carmichael, CaliforniaAt the time of study, Dr. Kohatsu was with the Department of Health Care Services, Sacramento, California
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Kizer KW. Advancing Tobacco Control Among Medicaid Beneficiaries: A Historical Perspective and Call to Action. Am J Prev Med 2018; 55:S222-S226. [PMID: 30454677 DOI: 10.1016/j.amepre.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/05/2018] [Accepted: 08/21/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Kenneth W Kizer
- University of California Davis School of Medicine, Sacramento, California; Betty Irene Moore School of Nursing, Sacramento, California; Institute for Population Health Improvement, Sacramento, California.
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Schroeder SA. California Promotes Smoking Cessation for Medicaid Enrollees: Lessons for the Nation? Am J Prev Med 2018; 55:S123-S125. [PMID: 30454665 DOI: 10.1016/j.amepre.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/05/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Steven A Schroeder
- Department of Medicine, Smoking Cessation Leadership Center, University of California, San Francisco, San Francisco, California.
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Roeseler A, Kohatsu ND. Advancing Smoking Cessation in California's Medicaid Population. Am J Prev Med 2018; 55:S126-S129. [PMID: 30454666 DOI: 10.1016/j.amepre.2018.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 05/15/2018] [Accepted: 07/20/2018] [Indexed: 10/27/2022]
Affiliation(s)
- April Roeseler
- California Tobacco Control Program, California Department of Public Health, Sacramento, California.
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Vijayaraghavan M, Dove MS, Stewart SL, Cummins SE, Schillinger D, Kohatsu ND, Tong EK. Racial/Ethnic Differences in the Response to Incentives for Quitline Engagement. Am J Prev Med 2018; 55:S186-S195. [PMID: 30454673 DOI: 10.1016/j.amepre.2018.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 07/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Certain racial and ethnic minorities have lower utilization of tobacco cessation services, such as Helpline counseling and cessation medications. The goal of the California Medicaid (Medi-Cal) Incentives to Quit Smoking Program was to facilitate successful cessation by promoting modest financial and cessation medication-related incentives to increase engagement with the California Smokers' Helpline counseling services. Differences in the response to incentives and outreach on engagement with Helpline services among racial/ethnic groups within the Medi-Cal population were examined. STUDY DESIGN Analysis of Helpline caller data. SETTING/PARTICIPANTS African American (n=18,656); English-speaking Latinx (n=12,792); Spanish-speaking Latinx (n=3,254); and white (n=45,907) Medi-Cal callers. INTERVENTION The Medi-Cal Incentives to Quit Smoking team conducted statewide and community-based outreach and facilitated direct-to-member all-household mailings about the Medi-Cal Incentives to Quit Smoking program to engage with Medi-Cal callers and promote Helpline services between March 2012 and July 2015 (analyzed 2017/2018). Medi-Cal callers could ask for a $20 gift card incentive after having completed a counseling session; in September 2013, callers were offered free nicotine replacement therapy. MAIN OUTCOME MEASURES Three behavioral outcomes are reported that reflect activated callers and callers who engaged in treatment that is proven to improve chances of quitting smoking: receipt of the $20 incentive, receipt of nicotine replacement therapy, and receipt of counseling. RESULTS African Americans and English-speaking Latinx had higher engagement with the financial incentive than whites (African American APR=1.66, 95% CI=1.59, 1.73, English-speaking Latinx APR=1.29, 95% CI=1.22, 1.36). Spanish-speaking Latinx had lower initial engagement with the financial incentive (APR=0.75, 95% CI=0.66, 0.85), but higher engagement with Medi-Cal's all-household mailing (Spanish-speaking Latinx 30.6% vs whites 18.2%, p<0.001). Although African Americans and English-speaking Latinx had similar rates of completing counseling and receiving nicotine replacement therapy as whites, Spanish-speaking Latinx had higher rates than whites. CONCLUSIONS The promotion of modest financial and cessation medication incentives through multiple outreach channels increased callers' engagement with the Helpline and appeared to promote ethnic and linguistic equity with respect to the receipt of counseling and nicotine replacement therapy. Targeted community-based outreach may resonate particularly for African Americans, and language-concordant Medi-Cal insurance plan mailings may have reached newly covered Spanish-speaking Latinx. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Affiliation(s)
- Maya Vijayaraghavan
- Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California.
| | - Melanie S Dove
- Division of General Internal Medicine, University of California, Davis, Davis, California
| | - Susan L Stewart
- Division of General Internal Medicine, University of California, Davis, Davis, California
| | - Sharon E Cummins
- Departmet of Family Medicine and Public Health, University of California, San Diego, San Diego, California
| | - Dean Schillinger
- Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California
| | | | - Elisa K Tong
- Division of General Internal Medicine, University of California, Davis, Davis, California
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Saw A, Stewart SL, Cummins SE, Kohatsu ND, Tong EK. Outreach to California Medicaid Smokers for Asian Language Quitline Services. Am J Prev Med 2018; 55:S196-S204. [PMID: 30454674 DOI: 10.1016/j.amepre.2018.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/05/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Asian male immigrants have high smoking rates. This article describes outreach approaches in the Medi-Cal Incentives to Quit Smoking project to incentivize California Medicaid (Medi-Cal) calls to the California Smokers' Helpline (Helpline) Asian-language lines. METHODS Outreach efforts adapted Medi-Cal Incentives to Quit Smoking materials for the Asian-language lines. Community-based efforts included outreach at ethnic supermarkets and distribution through community networks. Leveraging the Helpline's Asian print media campaign, three press releases promoted Medi-Cal Incentives to Quit Smoking with Lunar New Year or community physician messaging. Medi-Cal all-household mailings with tracking codes also included the Asian-language lines. Helpline caller characteristics and trends were examined for project period 2012-2015. Analyses were conducted in 2018. RESULTS Among 4,306 Asian American Pacific Islander Medi-Cal callers, there were 37% Asian-speaking Asian Americans (9.5% Chinese, 17.2% Vietnamese, and 10.5% Korean); 44% English-speaking Asian Americans; 9% Pacific Islanders; and 10% Asian American Pacific Islander not otherwise specified. Almost 10% of Asian-speaking Asian Americans were activated by the financial incentive and this was similar for all-household mailings, although this was lower than the other groups. Medi-Cal calls to the Asian-language lines increased, from an average of 18 calls/month to 47 calls/month (162% increase) in the first and last 12 project months respectively. Community outreach was limited by timing and sustainability. The 3-month call totals before and after the Asian-language press releases were significantly greater for Asian-speaking calls than for English-speaking calls (Cochran-Mantel-Haenszel p<0.001, OR=1.70, 95% CI=1.45, 1.99). CONCLUSIONS Whereas community outreach is challenging, promising population-based methods for in-language, culturally tailored outreach can include press releases with ethnic media and direct-to-member mailings. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Affiliation(s)
- Anne Saw
- Department of Psychology, DePaul University, Chicago, Illinois.
| | - Susan L Stewart
- Department of Public Health Sciences, University of California, Davis, Sacramento, California
| | - Sharon E Cummins
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
| | | | - Elisa K Tong
- Department of Internal Medicine, University of California, Davis, Sacramento, California
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Medi-Cal Incentives to Quit Smoking Program: Reach to Pregnant and Parenting Women. Am J Prev Med 2018; 55:S205-S213. [PMID: 30454675 DOI: 10.1016/j.amepre.2018.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 07/13/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In California, half of pregnant women and children are on California's Medicaid (Medi-Cal). The Medi-Cal Incentives to Quit Smoking program provided incentives to adults on Medi-Cal to call the California Smokers Helpline (Helpline) from March 2012 to July 2015. This analysis examined reach of the Medi-Cal Incentives to Quit Smoking program among pregnant and parenting women. METHODS This study examined caller data from the Helpline from 2010 to 2015 among women of reproductive age (18-45 years) enrolled in Medi-Cal (n=32,691; analyzed in 2017/2018). The authors calculated the annual percentage of the target population reached who called the Helpline by pregnancy status and used adjusted prevalence ratios to examine the associations between Medi-Cal Incentives to Quit Smoking incentive period, pregnancy/parenting status, Medi-Cal Incentives to Quit Smoking incentives ($20 gift card and nicotine patch), and counseling. RESULTS Over the study period, the percentage of the target population reached increased for women of reproductive age (2.1% in 2011 to 3.0% in 2014) and pregnant women (2.1% in 2011 to 3.3% in 2014). The percentage of women who asked for the $20 gift card (13.6%) was not substantially different by pregnancy status, and WIC and nonprofits were important referral sources. Pregnant women were less likely to receive nicotine patches, but there was a 3- to 4-fold increase during the Medi-Cal Incentives to Quit Smoking incentive period for both pregnant and nonpregnant women. Among nonpregnant women, counseling decreased 14% during the Medi-Cal Incentives to Quit Smoking incentive period. CONCLUSIONS Results suggest that the nicotine patch incentives motivated women to call the Helpline, even pregnant women who needed a physician's approval consistent with current American College of Obstetricians and Gynecologists cautions about the appropriateness of the patch during pregnancy. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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