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Improving Tobacco Cessation

Tobacco use is the leading cause of preventable deaths in the United States, and is one of the greatest drivers of costs in health care. States can reduce smoking rates and health care costs, and improve health outcomes by investing in comprehensive tobacco cessation programs. Tobacco dependence treatment is one of the most cost-effective preventive services, providing substantial return on investment in both the short and long term.

The Centers for Medicare & Medicaid Services (CMS) has issued an informational bulletin and offers quality improvement (QI) technical assistance to help states improve their tobacco cessation services for beneficiaries of Medicaid and the Children’s Health Insurance Program (CHIP). The QI technical assistance includes ideas for tobacco cessation QI activities and illustrative state examples of successful tobacco cessation programs. CMS also created resources on getting started with QI and how to use data for QI. In addition, CMS offers technical assistance focused on special populations, such as pregnant people and adults with behavioral health conditions.

For more information on these materials and other QI technical assistance, please email MedicaidCHIPQI@cms.hhs.gov.

Getting Started with QI

Here are some technical assistance tools to help states interested in developing their own tobacco cessation QI projects get started:

  • Improving Tobacco Cessation for Medicaid and Children’s Health Insurance Program Beneficiaries: Getting Started on Quality Improvement. This video provides an overview of how Medicaid and CHIP agencies can start a QI project to increase tobacco cessation. The Model begins with driver diagrams and small tests of change, enabling state teams to “learn their way” toward strong programs and policies.
  • Tobacco Cessation Driver Diagram and Change Idea Table. A driver diagram is a visual display of what “drives” or contributes to increased tobacco cessation. This example of a driver diagram shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms in the system that must change to increase tobacco cessation) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are made to spur improvement). The document also includes a change idea table, which contains examples of evidence-based or evidence-informed tobacco cessation QI interventions. The change ideas presented are tailored for Medicaid and CHIP leaders.
  • Tobacco Cessation Measurement Strategy. This measurement strategy provides examples of measures that can be used to monitor tobacco cessation QI projects.

For more information on these materials and other QI technical assistance, please email MedicaidCHIPQI@cms.hhs.gov.

Using Data for QI

Measurement and data are essential for QI. States use data to direct tobacco cessation interventions toward specific populations, identify best practices, and monitor the impact of QI programs.

States can use a variety of measures to assess tobacco use and the utilization of tobacco cessation services. A key Medicaid metric is the Medical Assistance with Smoking and Tobacco Use Cessation (MSC) measure, included in the Adult Core Set. This survey measure assesses three components of tobacco cessation support: (1) advising tobacco users to quit, (2) discussing cessation medications, and (3) discussing cessation strategies.

In the issue brief below, CMS describes how the MSC measure can be used to gauge the percentage of adult Medicaid beneficiaries who received tobacco cessation support and conduct subgroup analyses based on sociodemographic and health characteristics:

Tobacco Cessation Measures for Quality Improvement provides more examples of measures that can be used to develop and monitor tobacco cessation QI projects.

For more information on these materials and other QI technical assistance, please email MedicaidCHIPQI@cms.hhs.gov.