Rapid implementation of a smokers' quitline fax referral service in an urban area.

PURPOSE: To increase use of fax referral services to a state smokers' quitline. DESIGN: Program evaluation. SETTING: A populous urban county. SUBJECTS: Smokers older than 17 years. INTERVENTION: In January 2005, a state-funded smoking cessation center began to offer training and technical assistance to clinical sites to expand tobacco control services. MEASURES: Proportion of each county's smokers referred to quitline. RESULTS: Prior to program onset, only one Bronx provider had made a fax referral to the quitline. In 2006, 943 fax referrals were made, representing 0.5% of all smokers in the county. This was a higher proportion than any other state county with an adult population exceeding 250,000. Bronx smokers are 2.47 times more likely to be fax-referred to the quitline than other smokers in New York. CONCLUSION: A program consisting of training and technical assistance, and emphasizing systems change, can markedly increase providers' use of quitline referral services.

Using direct mail to prompt smokers to call a quitline.

Telephone quitlines efficiently deliver cessation services, but few smokers use them. This article describes an unsolicited direct mail campaign designed to increase calls to the New York State Smokers' Quitline. Two post-cards advertising the quitline and the availability of free nicotine patches were sent to 77,527 smoker households between August and October 2005. One postcard emphasized the effectiveness of the nicotine patch, whereas the other contrasted the risks of smoking and patch use. Response was evaluated using geographically linked calls to the quitline 15 days before and after each mailing. The postcard campaign increased call volume by 36%, with no difference between the two postcard versions. Those who reported calling the quitline in response to a mailing were more likely to request nicotine patches (91% versus 82%, p < .001). Direct mail can be used to increase quitline call volume and should be one of the promotional tools used by quitlines.

Implementation of an Inpatient Electronic Referral System (Opt-to-Quit) From the Electronic Health Record to the New York State Smokers' Quitline: First Steps.

OBJECTIVES: (1) To implement a new policy-driven referral program, Opt-to-Quit, using electronic data transfer from the electronic health record (EHR) to the New York State Smokers' Quitline (NYSSQL) and (2) to improve referrals to the NYSSQL for smoking caregivers of children admitted to a children's hospital. METHODS: Smoking caregivers of pediatric patients were referred to the NYSSQL through a standardized template built into the EHR, during the child's hospitalization or emergency department encounter. Direct data exchange was based on a point-to-point protocol, without dependence on any external centralized processing service. Input and oversight were provided by a multidisciplinary task force, which included physician and nursing leadership, information technology specialists, Health Insurance Portability and Accountability Act compliance personnel and legal counsel, and NYSSQL staff. The process was refined through several iterative plan-do-study-act cycles, using a single-armed, prospective cohort study design, including surveys of nursing staff and continued input of information technology experts on both hospital and Quitline sides. RESULTS: In 2013, 193 smokers were identified in 2 pilot units; 62% (n= 119) accepted referral to the NYSSQL. In 2014, after expansion to all inpatient units and the emergency department, 745 smokers were identified, and 36% (n = 266) accepted referral. Over the 2 years, overall increase in referrals was 124%; as of the first quarter of 2015, referral rate was sustained at 34%. CONCLUSIONS: Hospital-wide implementation of the Opt-to-Quit program through our EHR was feasible and sustainable and has significantly improved referrals to the NYSSQL.