Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers

Health care systems are key channels for delivering tobacco cessation treatment to the
smokers in a population. Current health care system approaches require busy clinicians with
many competing demands on their time to initiate treatment in the course of clinical
encounter. A population-based approach is an alternative that could complement office-based
care and offload busy clinicians. The ongoing evolution of the health care system is making
this more feasible with adoption of electronic health records (EHR) that document patients'
smoking status in a coded field. This facilitates the creation of a registry of smokers who
can be offered tobacco treatment proactively. However, the optimal way to implement a
proactive population health strategy for tobacco users is unclear.

The goal of the project is to implement a population-based proactive outreach program to
current smokers in a health care system's primary care practices. The program will

1. Proactively contact smokers independent of their health care visits and

2. Connect smokers who respond to evidence-based tobacco cessation resources available in
the health care system and/or community.

The study aims of the study are to:

Aim 1: To determine the feasibility and reach of the program.

Aim 2a: To determine whether the two intervention arms combined increase the proportion of
smokers who use tobacco cessation treatment over a 6-month follow-up, compared to those
receiving usual clinical care.

Aim 2b: To determine whether each of the two interventions increases the proportion of
smokers who use tobacco cessation treatment over a 6-month follow-up, compared to those
receiving usual clinical care.

Exploratory aim: To compare the 7-day point prevalence smoking cessation rate in each
intervention arm to usual care.

Inclusion Criteria:

- Seen at a participating Massachusetts General Hospital (MGH) Primary Care practice
within the linkage cohort time period

- "Current Smoker" as reported within the year based upon structured field in the health
monitoring section of the electronic health record, or problem list term

- Listed telephone number

Exclusion Criteria:

- Excluded by primary care provider

- No telephone in electronic health record or at primary care provider's office

- Non-English speaking

- Problem list has a diagnosis of dementia, psychosis, schizophrenia, Alzheimer's
disease, delirium, schizoaffective disorder, or suicidal tendencies.