Virginia Makes Tobacco Screening and Cessation Interventions a Burning Issue
Virginia Health Quality Center (VHQC) is Virginia’s Medicare Quality Improvement Organization (QIO). It also runs the Virginia Health IT (VHIT) program, which serves as Virginia’s regional extension center (REC). VHQC recognized smoking as a significant health issue in Virginia and developed an action plan, based on stage 1 meaningful use principles, to mitigate the problem. The plan leverages QIOs and RECs, which provide support to physician practices that use health IT to improve patient care.
1.1 Million Virginians Smoke
Nationally, smoking kills more people than alcohol, car crashes, illegal guns, murders, and suicide combined. The 2009-2010 National Adult Tobacco Survey, which found that 18.5% of Virginians smoke, indicates that smoking is a particularly significant health concern in Virginia. In part, VHQC’s work was motivated by the economic impact that smoking has in Virginia:
- Smoking directly accounts for $2.08 billion in annual healthcare costs in Virginia; and
- Smoking-related illnesses cost Virginia’s Medicaid program $401 million.
Meaningful Use Helps Set Practice Based Goals
In light of these data, VHQC sought to improve smoking assessment and cessation intervention rates. To do so, VHQC first reviewed the meaningful use stage 1 core objectives of recording smoking status and reporting smoking-related clinical quality measures. It also analyzed the performance of REC-enrolled practices that had selected these clinical quality measures for meaningful use reporting, and of QIO-participating practices that report on these measures through the Center for Medicare & Medicaid Services’ Physician Quality Reporting System (PQRS). VHQC then identified the following goals:
- Improve the rate of screening and cessation intervention in QIO PQRS participating practices from 70% to 90%; and
- Spread innovation to practices participating in the QIO cardiac learning and action network, and statewide through Million Hearts, to achieve the Million Hearts 65% benchmark for smoking cessation intervention rates for all practices.
Identifying Potential Barriers to Improvement
VHQC plans to use EHR data to track progress towards goal achievement. There are several factors, though, that impact the quality and accuracy of EHR reporting data. In order to ensure consistent, high quality reporting, VHQC recommends their provider practices:
- Develop specific and standardized documentation processes to ensure smoking status and smoking cessation intervention data are captured in reportable EHR fields;
- Provide staff training on the defined documentation process; and
- Ensure smoking status and cessation intervention data are recorded by every staff member for every patient at every visit.
Developing and Implementing a Plan of Action
Drawing on the ONC Meaningful Use Vanguard (MUV) program, VHQC was able to collaborate with an elite group of providers to identify best practices for using an EHR to record smoking status, evaluate tobacco use, and implement smoking cessation interventions. Identified best practices include:
- Implement workflow-redesign principles to promote patient engagement and self-reporting;
- Use a patient portal to record demographics and capture smoking status;
- Review an EHR measure report card weekly to track provider performance; and
- Contact the EHR vendor immediately to resolve any functionality concerns that arise.
In order to facilitate spread of these best practices, VHQC will host educational teleconferences featuring MUVers and facilitate a mentorship program that pairs practices with MUVers that have demonstrated successful smoking cessation counseling approaches.
Information sharing between the REC and QIO staff was also critical in developing the action plan. The two programs coordinate closely to avoid duplication of effort and increase patient impact. This means more practices will have access to knowledge and resources they need to help Virginians stop smoking.
VHQC Provides Technical Assistance to Help Clinicians use EHRs to Measure and Track Success of Cessation Interventions
VHQC will also work with participating practices and their EHR vendors to design and implement clinical decision support alerts that will remind providers to update a patient’s smoking history and then offer patients the most appropriate evidence-based cessation intervention proven effective for their demographic.
Because the meaningful use data have only recently become available, it is too soon to determine preliminary success. VHQC is confident, however, that this initiative will help more Virginians obtain the physician support they need to stop smoking.
VHQC encourages other RECs to find ways to partner with the state’s QIO and stakeholder organizations. By joining together to share resources, you can support more physician practices and make a greater impact on your community.