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Quitting Tobacco Incentive Program: A Project Worth Saving

Posted By Matthew Francis, Friday, January 30, 2015
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Many epidemiologists know what it’s like to face a great project on the precipice of failing despite every effort to keep it alive. I hoped that neither of my two projects in Lane County, Oregon would be in this situation. As a 12-month Health System Integration Program (HSIP) fellow, you go in knowing that some of your projects are in need of improvement; that you as the fellow are the person who will provide a solution; and that the work is scoped to be resolved within 12 months. Despite my hopes and the efforts of the project team assigned to Tobacco Cessation in Pregnancy (TCIP), this is exactly where I found myself on one project. Truth be told, I couldn’t have been more thrilled to have the opportunity to keep a truly important public health project from being scrapped due to a shaky start.

The HSIP fellowship uniquely rests on the fulcrum between informatics and epidemiology. As an epidemiologist, my role is to design questionnaires, assist with analytics, support projects, and aid in the implementation of epidemiological methodologies. As an informaticist, I make sure the variables make sense and the radio buttons are in a logical order. I also name variables, create user-friendly databases, and write codebooks. Both skillsets were needed when the TCIP initiative was failing and the decision was made to move it to The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), rename it Quit Tobacco Incentive Program (QTIP), and change the way tobacco use was measured.

That transition was in the works when I arrived. After meeting with the QTIP team, it quickly became apparent that during year one of the program, due to such issues as their tobacco screening tool being unreliable and physicians and clinic staff overburdened and dropping out, there was no data infrastructure. As discussion revolved around moving the program to WIC, the same question kept surfacing, where will the data go?

When multiple physician offices were enrolling participants, the default option involved copying paper records to spreadsheets. This system, aside from transcription errors, faced an enormous challenge. The goal of the program was 80 percent enrollment of a projected 600 pregnant smoking Medicaid mothers. Since each mother would be interviewed six to seven times and their data would be entered twice—on paper and Excel—by one individual at WIC, the volume of data entry work was well above what a 0.2 full-time equivalent counselor could complete. Had the program been in its planning stage, perhaps this issue could have easily been resolved. However, with the program on the fast track and WIC gearing up for enrollment, each participant enrollment would create a more burdensome data system. The database also needed to contain a system where the WIC staff could take notes to assist in counseling support of the pregnant mother as well as adding to the existing data that was being collected. Lane County Prevention and WIC staff also felt the need to collect data on electronic cigarette usage, since there was concern that mothers might use e-cigs to aid in cutting back on traditional cigarettes.

With guidance and input from my mentor, the prevention team, local coordinated care organization, and WIC staff, we were able to develop an Access database with forms similar to the existing paper copies housed in WIC. We were also able to create a database for the WIC staff that was on time and flexible enough to be a useful tool for present and future enrollment. The new data tool allowed for WIC staff to provide a better overall experience for pregnant mothers interested in quitting. WIC staff was able to make notes, track progress, set reminders and have a system that quickly allowed them to pull participant data when needed to assist in tobacco cessation. Being an HSIP fellow allowed me to tackle the program improvement from two key perspectives. I was able to not only address the data needs of the program by creation of the data tool, I was also in the unique position to ensure that the transition from paper to database was as seamless as possible and was able to give recruitment guidance based on my previous experiences in the field.

An important takeaway from this project has been that despite funding and availability of resources, some projects hit early road blocks that can severely jeopardize their success. Having the correct informatics and epidemiological resources is a crucial component of successful programs. It takes a determined program staff to move forward during times of change and maintain the initial program vision. Integration of multiple health systems allowed for the continuation of a great public health program that had stumbled early on. Reintegration of clinics and physicians as referral tools is an important next step for the success of the program.

Matthew Francis, MS, PhD is a Health Systems Integration Program (HSIP) fellow at Lane County Health and Human Services in Eugene, Oregon. For more information on drug surveillance, read more at the Alcohol and Other Drug Surveillance Subcommittee. The HSIP fellow application is open until February 16, 2015.

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