St. Luke’s Health System is pursuing accountable care. For us, that means a focus on better health (improving the health of our communities), better care (constantly improving our care, implementing evidence-based best practices, and coordinating care effectively for those with chronic illnesses), and lower costs (through lower insurance premiums and efficient use of our resources).
We can’t improve and maintain peoples’ health without addressing tobacco use. Smoking and chewing tobacco have been associated with a host of medical problems that are expensive to treat and often shorten peoples’ lives.
Though my father stopped smoking more than a decade earlier, he developed a cancer, caused by his prior tobacco use, that eventually took his life. Seldom does a day go by that I don’t wish I still had my father to talk to. He was a wise man and a great role model for me. I miss him terribly.
I also vividly remember diagnosing lung cancer in a friend’s only child, a 23-year-old who had been smoking since her teens and who would end up dying later that same year. It was agonizing to have to tell her parents, who had brought her to see me thinking she was having asthma.
Decreasing tobacco use and preventing children from taking up smoking is personal. In my medical training and practice, I have seen the devastation that this addiction has caused. I remember a man who could not quit smoking even after he had throat cancer and surgery that resulted in him having to breathe, and consequently smoke cigarettes, through a hole in his neck.
I am thrilled that the SELECT Medical Network, the clinically integrated physician network that has our St. Luke’s Clinic physicians and independent physicians working together, has identified tobacco cessation as one of its top initiatives. If we can help even one person quit smoking and prevent one case of cancer and/or death, our efforts will be worth it.
I have asked Chereen Langrill, communications coordinator for SELECT Medical Network, to explain what actions the network is taking to improve the community’s health and save lives from this deadly addiction.
If someone you know and care about smokes, encourage them to stop and tell them that they don’t have to do it alone. There is help.
It is likely not surprising to hear that smoking and other forms of tobacco use can cause serious health threats, yet smoking and tobacco use continue to be a problem for many people.
St. Luke’s Health System recently conducted a Community Health Needs Assessment to identify the health needs in our communities. Some of those issues had to so with smoking and tobacco use.
According to the Comprehensive Cancer Alliance for Idaho, approximately 1,500 people in Idaho die each year because of tobacco use. Current statistics show that 17 percent of our population smokes. And cigarette smoking is known to be the leading cause of preventable death.
Yet quitting is difficult, given the addictive nature of nicotine.
Nicotine addiction comes in different forms. Smoking rates may be on the decline, but there are concerns that the use of e-cigarettes and chewing tobacco is increasing. There is evidence that high school students are still being persuaded to use tobacco; one in seven high school students smokes, and 9 percent use smokeless tobacco.
This risky behavior inevitably will cause significant and tragic consequences for many.
The St. Luke’s Healthy U program was developed in 2010 for employees and their families to improve their health, with incentives and programs focused upon health risks such as tobacco use. Employee engagement and accountability are built into the program through our value-based insurance design and premium advantages.
The program is now branching out to employers and other interested stakeholders in our communities.
Why is it important?
Studies show that approximately 70 percent of smokers say they want to quit smoking. Unfortunately, the national success rate ranges from 3 percent to 7 percent for smokers who try to quit on their own.
We are partnering with providers to design an evidence-based tobacco program to help people quit – and continue to be tobacco-free.
We know that we can have an impact on those influences, including behaviors such as diet, exercise, and smoking, that impact how healthy people will likely be in the future. While poor influences can lead to deadly consequences, such as cancer or cardiovascular disease, the good news is that those influences can be controlled using evidence-based programs such as our developing tobacco cessation program.
What’s the challenge?
The majority of smokers indicate they want to quit. The challenge is to remain tobacco-free. Long-term success is an uphill battle, but there is strong evidence supporting the increased success rate that comes from combining counseling and medication.
In addition, there is information suggesting the importance of giving patients the opportunity to consider quitting. Providers are encouraged to ask their patients about tobacco use during each visit. That simple question may lead to a conversation that is life-changing.
What’s the goal?
The goal is fewer people using tobacco within our communities. This will take all of us, working together, to arm people with the tools they need and to educate them. People need to understand why they should never start using tobacco in the first place, and we need to teach them why they should quit and how to do it successfully.
How will it make a difference for patients? What changes will they see?
When patients have a routine appointment with their care provider, they should expect to have a conversation about their tobacco use. Even if a patient doesn’t have a current desire to quit using tobacco, that initial question opens the door for future conversations. A tobacco-free lifestyle should last a lifetime, and this process may take some time and effort. It’s important not to give up or get discouraged.
What are the next steps?
A top reason people decide to quit is often concern about future health problems. Other motivating factors include the cost of smoking and current health problems.
These reasons often present opportunities. When someone expresses an interest in quitting, we must seize that opportunity to start the conversation.
What are the measures of success?
Our clinical integration scorecard will become a valuable tool to measure the success of the tobacco cessation program. We are educating our providers in the critical success factors involved in tobacco cessation, including the questions to ask patients at every visit.
As our data access and capabilities improve, we expect that providers will be able to view the number of tobacco users in their care, what percentage of their patients have been asked about tobacco issues, how many are being treated and the treatment methods being used, and the number of tobacco users who have quit and maintained cessation.
We anticipate long-term effectiveness will be seen through reduced rates of smoking-related diseases such as asthma, emphysema, heart and other vascular disease, and lung cancer.
Editor’s note: This is the second installment of a 10-part series introducing clinical integration initiatives that St. Luke’s is involved in.
Clinical integration is a term used to describe health care providers working together in an interdependent and mutually accountable fashion to pool infrastructure and resources. By working together, providers develop, implement and monitor protocols, “best practices,’ and various other organized processes that enable them to furnish higher quality care more efficiently than could be achieved working independently.
St. Luke’s Health System is a participating provider in the SELECT Medical Network of Idaho, Inc. SELECT is a network of healthcare providers in southwest Idaho that is focused on a coordinated model of care delivery focused on providing enhanced quality and better value to individuals, employers, and insurers.
In keeping with the clinical integration effort, 10 initiatives were developed for 2013 to help establish the standards of enhanced quality meant to help create a new vision for health care.
The initiatives are:
- Tobacco cessation
- Back program
- Advance directives
- Care management
- Medicine reconciliation
- Hand hygiene
- Pharmacy optimization
- Shared analytics