Sustainable Approaches to
Change: A Health System’s
Perspective on Tobacco
Cessation Strategy
Alexandria - dialysis, radiation oncology
Becker - clinic, pharmacy
Big Lake - clinic, dialysis
Brainerd - dialysis
Cambridge - dialysis
Eagle Bend - clinic
Litchfield - dialysis
Little Falls - dialysis, outreach clinic
Long Prairie - hospital, clinic, long-term
care
Melrose - hospital, clinic, long-term care
Monticello - senior housing
Princeton - dialysis
Sauk Centre - clinic
Staples - dialysis
St. Cloud - hospital, clinic, dialysis,
pharmacy, long-term care, senior housing
St. Joseph - clinic
www.centracare.com
Who we Are
 Four hospitals including St. Cloud Hospital which
serves as a regional medical center.
 Thirteen Clinic sites
 Outreach providing care in 10 specialty areas serving
over 30 cities.
 Potential patient population of 400,000 +
Where we Started
 Disjointed knowledge of what cessation services existed
within our own health system and in community.
 Limited efforts to engage our own employees who are
using tobacco and wish to quit.
 Poor capabilities within our electronic medical record to
assist providers with diagnosis, treatment and referral.
Where we Started
Accomplishments to Date
 Created a standing committee designed to address all aspects related to
cessation. The memberships consists of: Physician champion, pharmacist,
project manager, TTS trained counselors, hospital Heart Center
physiologists, respiratory therapy, nursing, marketing, and Foundation.
 A model of commitment from our own system. As of this spring benefits
for our employees now include: One-on-one cessation counseling covered
at 100% for those that have our insurance with no limits on number of
visits. Bupropion covered at 100%.
 Free 16 weeks of NRT’s. Available for those completing the Heart and
Vascular Center programming.
Accomplishments to Date
 Additional sites enrolled in the MN Fax Back Referral
System (11 in total)
 The higher dose recommendations for the nicotine patch
were adopted as best practice throughout the system
 EMR upgrade:
SmartSet Opens with all sections collapsed.
More than 40 cigarettes per day section after opening:
The first dose is “today’s” prescription
The subsequent titrated prescriptions have a comment to the pharmacist notifying of
titrated prescription and to hold until patient requests and previous regimen completed.
93%
63%
90% 92%
86%
79%
Sep-11
Aug-11
Jul-11
Jun-11
May-11
1 Qtr 11
% Chlamydia
% BMI
84% 85%
69%
58%
4 Qtr 10
Sep-11
Aug-11
Jul-11
May-11
Jun-11
53%
1 Qtr 11
93%
85%
73%
93%
4 Qtr 10
2 Qtr 10
1 Qtr 10
4 Qtr 09
3 Qtr 09
95%
94%
93%
3 Qtr 10
94%
97%
98%
100% 100%
3 Qtr 10
96%
96%
97%
Goal: 65%
92%
83%
2 Qtr 10
96%
99%
1 Qtr 10
98%
4 Qtr 09
98%
92%
% Chlamydia
Goal: 95%
3 Qtr 09
% BMI
Median
Median
% Tobacco Goal: 100%
Median
% Tobacco Status Asked
% Advised to Quit
Median
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
1 Qtr 11
4 Qtr 10
3 Qtr 10
2 Qtr 10
1 Qtr 10
% UTD Cervical Cancer Screening
1 Qtr 11
93% 92% 92% 93%
4 Qtr 10
94% 95%
3 Qtr 10
96%
2 Qtr 10
95% 95%
86%
4 Qtr 09
85%
95%
3 Qtr 09
90%
98%
1 Qtr 10
95%
4 Qtr 09
100%
3 Qtr 09
% UTD Cervical Cancer Screening Goal: 93%
100%
94% 91%
90% 93%
100%
85%
80%
90%
78% 78% 78%
80%
70%
58%
60%
47%
50%
40% 55%
50%
45% 45% 46% 48%
46%
30%
40%
33%
35%
30%
28%
20%
Reporting Capabilities
 # of patients provided with brief interventions
 # of patients referred either internally or externally
 # of prescriptions written for cessation medications
 List of tobacco trained specialist providers and other non-
provider experts throughout our system
 Provider specific registries showing tobacco users who
also have chronic conditions such as diabetes, vascular,
etc.
In Progress
 Development of a new department (Health &
Wellness)and director level position.
 Upgraded registry specific to tobacco use
 Negotiations with providers and clinic sites related to the
possibility of a hybrid payment system for 1:1 cessation
sessions.
Lessons Learned
 Don’t get ahead of your EMR build team!
 Tie your cessation efforts to the most high profile project
your health system is placing their resources.
 Highlight the importance of cessation efforts to your
clinicians in alternative manners. (registries)