Partnering to Help Home Health Patients Quit Tobacco

The New England Quality Innovation Network-Quality Improvement Organization (NE QIN-QIO) works closely with the New Hampshire Department of Health and Human Services (NH DHHS) to implement Million Hearts® strategies across the state. As part of the regional New England Home Health Collaborative, together the New England QIN-QIO and NH DHHS have worked to implement smoking cessation—one of the “ABCS of Heart Health”—at the state level in New Hampshire.

One of the original challenges facing NH DHHS was a lack of home health clinician knowledge about smoking cessation resources for patients, and clinician uncertainty about how to approach the subject with them.

Through the New England QIN-QIO’s partnership with the NH DHHS, 11 home health agencies were connected to the New Hampshire Tobacco Prevention and Cessation Program. A tobacco treatment specialist offered to provide on-site education at the agencies to increase awareness among clinical staff about the health risks of smoking. The partners worked to connect clinical staff directly with patients.

Cornerstone VNA, a home health agency serving 35 communities in southern New Hampshire and Maine, spearheaded the smoking cessation initiative within its organization. A key manager at Cornerstone VNA was identified to enter patient data into the Home Health Quality Improvement (HHQI) National Campaign’s Home Health Cardiovascular Data Registry. Initially it was challenging for the manager to identify appropriate resources and the steps necessary to accomplish the goals. To help streamline the process, home health staff at the New England QIN-QIO created the “Road Map to Success Implementation Checklist” tool to help agencies better navigate the registry and its deadlines.

We are connecting patients with resources that we never knew were available. Clinicians are more comfortable asking about smoking cessation with patients and connecting them with the resources they need to be successful.

  • Jennifer Gullison, RN, MSN
  • Clinical Director
  • Cornerstone VNA

To implement the smoking cessation initiative, a dedicated quality improvement team at Cornerstone VNA identified the data needed based on the measure it chose. In particular, team members needed to collect two pieces of information: whether the patient had been screened for tobacco usage and whether smoking cessation education had been provided for at least three minutes. Once this data was collected, Cornerstone VNA was able to implement specific clinician interventions into the care plan.

Through the New Hampshire Tobacco Prevention and Cessation Program, Cornerstone VNA received a customized referral form to refer patients to the New Hampshire Tobacco Helpline. The program also provides smoking cessation patient education booklets, which the New England QIN-QIO shares with providers. “We are connecting patients with resources that we never knew were available. Clinicians are more comfortable asking about smoking cessation with patients and connecting them with the resources they need to be successful,” said Jennifer Gullison, RN, MSN, clinical director at Cornerstone VNA.

Cornerstone VNA closely monitors HHQI data on a monthly basis to identify what additional education is needed for its patient population. The staff educator at Cornerstone VNA brings concerns to the clinical director and works to reeducate staff—all of whom are trained on the initiative—when they see numbers begin to rise. Since implementing the initiative, 100 percent of Cornerstone VNA patients have been screened, and patients who agreed to quit smoking have received education and resources.

Tobacco Use: Screening & Cessation

Percentage of patients aged 18 years and older who were screened for tobacco use by the home health agency AND who received cessation counseling/intervention by the home health agency

MAR 2015 APR 2015 MAY 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Total
# of Episodes Screened and Receiving Cessation Intervention 0 0 0 9 12 11 18 21 23 23 22 24 163
Total Eligible Episodes Abstracted-Agency 0 0 0 12 12 12 20 21 24 23 22 24 170
Agency Measure Compliance % 75 100 91.67 90 100 95.83 100 100 100 95.88
Total Data Registry Measure Compliance % * 85.89 86.71 88.29 84.24 82.78 82.75 84.22 80.57 79.79 83.44 84.42 88.39 84.29
# of Episodes Screened for Tobacco Use 0 0 0 12 12 12 20 21 24 23 22 24 170
Total Eligible Episodes Abstracted-Agency 0 0 0 12 12 12 20 21 24 23 22 24 170
Agency Measure Compliance % 100 100 100 100 100 100 100 100 100 100
# of Episodes Receiving Cessation Interventions 0 0 0 0 0 0 4 2 5 5 2 2 20
Total Episodes of Screened Tobacco Users 0 0 0 3 0 1 6 2 6 5 2 2 27
Agency Measure Compliance % 0 0 66.67 100 83.33 100 100 100 74.07
Tobacco Graph