• Printer-friendly Adult Clinical Measure 9: Tobacco Detail Sheet (Acrobat/pdf)

# of adults with documented tobacco use (smoke, chew, snuff, etc) who:

• were 18 or over during the calendar year of interest
• were served in the calendar year of interest
• were counseled to quit and/or have been given a treatment plan to quit documented in the calendar year of interest
  

# of adults with documented tobacco use (smoke, chew, snuff, etc) who:

• were 18 or over during the calendar year of interest and were served in the calendar year of interest

HEDIS: 66.0% of the smokers 18 and older in the average managed care plan were advised to quit during a visit with their physician (drawn from a survey of “randomly selected health plan members… [who] reported recent smoking and a visit to the doctor during the previous year were asked whether their physicians had advised them to quit during that visit.”); see:
http://www.ncqa.org/somc2001/ADVISE_SM/SOMC_2001_ADVISE_SM.html

If Chart Audit, then sample from the sample frame of persons meeting denominator criteria.
This measure is likely to require an extensive chart audit. Since most grantees won’t know in advance which patients use tobacco products, a large number of charts must be sampled in order to get a sample size of smokers sufficient to draw meaningful conclusions from the audit.

The hazards of tobacco use have been well documented. Nicotine is one of the most heavily used addictive drugs in the U.S. The tar in cigarettes increases a smoker’s risk of lung cancer, emphysema, and bronchial disorders. The carbon monoxide in smoke increases the chance of cardiovascular diseases. In addition, secondhand smoke causes lung cancer in adults and greatly increases the risk of respiratory illness in children.
In 2002, 30% of the U.S. population used tobacco at least once in the month prior to being interviewed (NIDA Info facts: Cigarettes and Other Nicotine Products).

For further information , see:
http://www.drugabuse.gov/drugpages/nicotine.html

For more on tobacco use and cessation, see:
http://www.cdc.gov/tobacco/index.htm
&
http://www.cancer.gov/cancertopics/factsheet/Tobacco

For information on the measure, see:
http://www.healthdisparities.net/hdc/html/collaboratives.topics.prevention.aspx (#3a)
&
http://www.ncqa.org/Docs/SOHCQ_2005.pdf (page 47)

• “Cigarette smoking is the leading cause of preventable death in the United States and produces substantial health-related economic costs to society” Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic Costs — United States, 1995–1999. MMWR 2002; 51:300-303. (http://www.cdc.gov/mmwr/PDF/wk/mm5114.pdf)
  
• “20.9 percent (44.5 million) of adults in the United States were current smokers in 2004—down from 22.5 percent in 2002 and 24.1 percent in 1998. An estimated 45.6 million adults were former smokers, representing 50.6 percent of those who had ever smoked. The steady decline in smoking prevalence has been observed nationally, but in some segments of the population smoking prevalence remains high. Comprehensive tobacco control programs need to ensure that their prevention and cessation efforts reach persons with inadequate resources and limited access to health care.” Centers for Disease Control and Prevention. Cigarette Smoking Among Adults — United States, 2004. MMWR 2005; 54(44); 1121-1124. (http://www.cdc.gov/mmwr/PDF/wk/mm5444.pdf)
  
• “All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates.” http://www.surgeongeneral.gov/tobacco/treating_in,tobacco_use.pdf

“Clinicians should provide tobacco use cessation counseling at every clinical encounter” (Tobacco-Cessation Patient Counseling: American College of Preventive Medicine Practice Policy Statement, http://www.acpm.org/tobpol.htm)