• Office of Quality and Performance (10Q). FY 2008, Q1 technical manual for the VHA performance measurement system. Washington (DC): Washington (DC); 2007 Oct 31. 315 p.

Does not apply to this measure

This measure is used to assess the percent of patients using tobacco who have been offered a referral to smoking cessation specialty program to assist with cessation within the past year.

According to the Center for Disease Control (CDC), about 8.6 million people in the United States have at least one serious illness caused by smoking. Smoking-attributable illness is a major contributor to the $75 billion per year in direct medical costs from smoking. Approximately 440,000 people in the United States die each year of a smoking-related illness, resulting in 5.6 million years of potential life lost and $82 billion in lost productivity from smoking. For every person who dies of a smoking-related disease, there are 20 more people suffering with at least one serious illness from smoking. Among current smokers, chronic lung diseases account for 73% of smoking attributable conditions. Among former smokers, chronic lung diseases account for 50% of smoking attributable conditions, followed by heart attacks (24%). Many more people are harmed by tobacco use than are indicated by death rates alone, and more individuals will experience serious chronic diseases attributed to smoking if they continue to smoke.

Smoking accounts for one out of every five deaths in the U.S. It is the most important modifiable cause of premature death, responsible annually for an estimated 5 million years of potential life lost. Tobacco cessation counseling on a regular basis is recommended for all persons who use tobacco products. Smoking is the leading cause of preventable death and disease in the U.S. Veterans receiving care in the Veterans Administration (VA) healthcare system are disproportionately affected by smoking-related illnesses as they smoke at higher rates than the general population.

Effective, evidence-based interventions exist for controlling and preventing many chronic diseases. In the case of smoking cessation, there is a large body of evidence providing strong support that counseling and medications are effective in helping smokers quit. Implementing proven clinical smoking cessation interventions would cost an estimated $2,587 for each year of life saved, the most cost-effective of all clinical preventive services.

Tobacco use; smoking cessation specialty program

All patients from the NEXUS cohort using tobacco (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Patients using tobacco who, within the past year, have been offered referral to cessation program (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence
• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Unspecified

Current routine use

External oversight/Veterans Health Administration
Internal quality improvement

Ambulatory Care

Advanced Practice Nurses
Dentists
Nurses
Physician Assistants
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Social Workers

Single Health Care Delivery Organizations

Unspecified

Either male or female

Unspecified

Unspecified

Unspecified

See the "Rationale" field.

Unspecified

See the "Rationale" field.

Staying Healthy

Effectiveness

Users of care only

All patients from the NEXUS cohort* using tobacco

*Refer to the original measure documentation for patient cohort description.

Patients associated with provider

Inclusions
All patients from the NEXUS cohort* using tobacco**

*Eligible patients: Meets cohort selection criteria and documented in the medical record the patient is currently using tobacco. If the patient's response is vague or ambiguous or documentation is conflicting (tobacco user and non-tobacco user both documented), patient is considered to be using tobacco.

**If a patient was not screened in the past 12 months and not known to be a lifetime non-tobacco user, or quit greater than 7 years ago, they are presumed to use tobacco and are included in the denominator (count against the facility).

Exclusions

• Patients who have reported successfully quitting in the last 12 months.
• Do not have a life expectancy that lends itself to prevention screening.
• Any of the following exclude the patient from screening for the prevention measure:
  • Documented diagnosis of cancer of esophagus, liver or pancreas;
  • Enrolled in a Veterans Health Administration (VHA) or community-based hospice program;
  • Documented in the medical record a life expectancy less than 6 months on the PROBLEM LIST or as a Health Factor in Computerized Patient Record System (CPRS).

All cases in the denominator are equally eligible to appear in the numerator

Encounter
Patient Characteristic

Time window precedes index event

Inclusions
Patients using tobacco who, within the past year, have been offered referral to cessation program

Note:

• Referral to cessation program: Patient may refuse to participate but documentation must indicate that program was offered. This referral should optimally be to inform the patient of services available through a Veterans Affairs (VA) Smoking or Tobacco Use Cessation Specialty Clinic or a VA provider who is the local specialist in evidence-based smoking cessation care, if such a clinic or provider is available to the patient. If the patient cannot or will not attend a VA clinic, or if one is unavailable, the provider can also offer to refer the patient to a local smoking cessation program in the community, such as one available through the American Lung Association, the American Cancer Society, or a state telephone counseling quitline, as appropriate.
• Any provider who is able to refer would be able to provide brief counseling and/or refer to a specialty smoking cessation clinic, including physicians, Nurse Practitioners(NPs)/Physician Assistants(PAs), Registered Nurses (RNs), social workers, psychologists, dentists, substance abuse counselors, and others.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Fixed time period

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Smoking cessation: offered referral to smoking cessation clinic to assist with cessation.

Veterans Health Administration

Unspecified

Unspecified

Unspecified

Measure was not adapted from another source.

2007 Oct

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

• Office of Quality and Performance (10Q). FY 2008, Q1 technical manual for the VHA performance measurement system. Washington (DC): Washington (DC); 2007 Oct 31. 315 p.

This NQMC summary was completed by ECRI Institute on March 31, 2008. The information was not verified by the measure developer.

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