BMJ  2008;336:1016-1019 (3 May), doi:10.1136/bmj.39510.805266.BE

Practice

Quality Improvement Report

A framework for tobacco control: lessons learnt from Veterans Health Administration

Scott E Sherman, associate professor of medicine1

1 VA New York Harbor Healthcare System/New York University School of Medicine, New York, NY 10010, USA

Correspondence to: S E Sherman, VA New York Harbor Healthcare System (111), 423 East 23rd Street, New York, NY 10010 scott.sherman@med.nyu.edu

The first 150 words of the full text of this article appear below.

Despite considerable progress, smoking remains the leading preventable cause of death in the United States, responsible each year for 435 000 deaths1 and $157bn (£79bn; {euro}103bn) in health related losses.2 Each pack of 20 cigarettes leads to $3.45 in medical expenditures and $3.73 in lost productivity.2 When Maciosek et al recently prioritised 25 preventive interventions, factoring in burden of disease and cost effectiveness, tobacco control was tied for the top priority, and better screening followed by brief intervention yielded a greater benefit in quality adjusted life years than the next 10 interventions combined.3 Similarly, the Institute of Medicine recently identified improving treatment for tobacco use as one of the top 20 healthcare priorities.4 5

No clear guidance exists for improving the performance of a healthcare system to the goals set by Maciosek.3 The Public Health Service guidelines suggest that providers focus on five steps, outlined in figure 1Go,6 and these . . . [Full text of this article]

Abstract


A four stage framework for tobacco control


Stage 1—no system for tobacco control
Stage 2—systematic screening
Stage 3—systematic treatment
Smoking cessation strategies used at VHA
Stage 4—population health

Lessons learnt


Tobacco control is a systemissue
Practice guidelines are necessary
Measuring performance is essential
Performance measures must be tied to incentives
Achieving adherence to guidelines requires additional system support
Systematically identify and disseminate best practices

Relevance for other healthcare systems


Next steps



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Rapid Responses:

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Need to incorporate framework in tobacco control programmes
Om Prakash
bmj.com, 4 May 2008 [Full text]



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