Quit Tobacco Incentive Program: Collaborative Health Systems Integration in Tobacco Cessation

BACKGROUND: The Tobacco Cessation Incentive Program was an integrated health systems project aimed at assisting pregnant Medicaid patients in cessation through a multi-visit incentivized approach funded by a local coordinated care organization (CCO). Using providers as the primary method of enrollment women were tested for cotinine levels 3 times during pregnancy and twice after delivery, incentives were given after negative cotinine tests. At the end of the first year enrollment numbers were not being met and program staff decided to change how women were enrolled from physicians’ offices to Lane County WIC, method of tobacco detection and how motivation and support was offered to quitting mothers. The project was changed to Quit Tobacco Incentive Program and a centralized support structure was created revolving around WIC.

METHODS: A full time Community Service Worker (CSW) was hired to manage enrollment, tract data, and assist in tobacco cessation and was located in WIC to better facilitate the enrollment of eligible Medicaid smokers. An access database was created to move away from the original paper copies to a digital system. Paper forms were re-created in Access to assist in the capturing, storing and analyzing of data. WIC CSW used the 5As cessation approach to guide and support quitting mothers and tobacco use was determined by carbon monoxide readings.

RESULTS: At the end of the first year of the project 74 women (<20%) were enrolled in the project, totaling 196 person-months of enrollment. Original program goal was enrollment of 80% of pregnant Medicaid patients that smoked. A program goal of 30% cessation of participants was also set and not met at the end of year one. Of those that participated 4 of 74 women (5%) were tobacco free at their 3^rdprenatal visit, and only 1 of 27 mothers to deliver had stopped smoking.

CONCLUSIONS: Clinical staff during year one of the project were over-burdened and could not promote the program or track participants at the level needed for success of the project. Public Health and the CCO felt that this was a worthwhile project and changes were made to try and improve enrollment and participation in the program. Public Health decided to house the program in WIC with the hopes that WIC would enroll women, provide motivational support, tract participants and issue incentives. A collaborative health systems dynamic allowed for the incorporation of other key partners to help ensure success of the program.