Implementing tobacco tracking codes in an individual practice association or a network model health maintenance organisation.

The Providence Health System (PHS) in Oregon is an individual practice association model health maintenance organisation with more than 300 000 covered lives in our capitated model and more than 360 000 members in our preferred provider model, which is a discounted fee for service structure. PHS has 12 000 employees, over 1400 acute and long term beds, and a demonstrated commitment to social accountability. Tobacco cessation programs are one of the top priorities for reducing overall cardiac morbidity and mortality. A regional health system task force for tobacco cessation comprised of key personnel and stakeholders was formed in 1994 (table 1). The physician leader’s role was to educate medical care providers on smoking cessation, while the program development administrator helped coordinate activities and was instrumental in securing funds for all initiatives. Health education played a critical role in administration of the intensive cessation interventions and other member focused interventions. Health plan involvement was important in changing the benefit structure of the health plan to broaden coverage for smoking cessation programs. Pharmacy input was needed with the advent of several new pharmaceutical tobacco cessation interventions. The PHS smoking cessation task force developed a multifaceted approach to tobacco cessation (fig 1). The overall program starts with a variety of cessation services oVered to our patients. The group support program is a 10 session behaviour modification class. The telephone support program (“Free & Clear”, Group Health Cooperative, Puget Sound) is provided to members. The individual support intervention (one on one), for highly comorbid patients who have failed group support, consists of individual counselling with a highly trained smoking cessation counsellor for 12 months. The task force developed self help materials in Spanish and Russian. We have a pharmacotherapy benefit for the over the counter nicotine patch and bupropion (Zyban; GlaxoWellcome), which is linked to participation in a structured behavioural modification program. To any interested clinic, we oVer, at no cost, a tailored training program based on the 4A’s developed by the National Cancer Institute, refined by researchers at the northwest region of Kaiser Permanente, which draws from the “stages of change” theory and “self determination” theory. PHS recently received full accreditation from the National Committee for Quality Assurance, and the eVorts in tobacco cessation played an important role in that accreditation. Specific groups are targeted for smoking cessation, including patients with coronary artery disease, diabetes, and asthma. Members of the PHS task force have been involved in community activities, such as the Tobacco Free Coalition of Oregon, and have helped shape the state of Oregon’s preventive strategy for the Oregon Medicaid Assistance Program. We have also implemented a hospital based smoking cessation intervention based on work by Stevens et al. In this program, every patient admitted to a PHS hospital is asked about current smoking status by the admitting department, and the smoking status of every patient is recorded in the hospital demographic database. Lists of inpatient smokers are printed Figure 1 Providence Health System (PHS) smoking cessation and prevention program 1999. TOFCO,Tobacco Free Coalition of Oregon; OMAP, Oregon Medicaid Assistance Program; PHP, Providence Health Plan; OHP, Oregon Health Plan; NCQA, National Committee for Quality Assurance; HEDIS, Healthcare Employer Data Information Set; C.O.R.E. Centre for Outcomes Research and Education; EMR, electronic medical record; CAD, coronary artery disease; DM, diabetes mellitus; Prov-RN, a telephone point of service patient advice line; PCP, primary care physicians. Target groups