1. Staff Training

2. MOQC/MCC Tobacco Cessation Patient Education Video: Why Cancer Patients Should Quit Tobacco

3. Agenda 1.Background 2.Future State 3.Change Packet 4.MOQC Resources 5.Next Steps

4. 1. Background

5. Background There is growing evidence that using tobacco: – Compromises the effectiveness of cancer treatments (e.g., chemotherapy, surgery) – Reduces treatment tolerance – Increases the risk of complications and the risk for a secondary primary cancer Stopping tobacco use immediately after being diagnosed with cancer gives patients the best chance for their cancer treatment to work

6. Background Oncologists play a vital role in tobacco cessation by providing the recommendation and education to patients to help them quit Clinicians can make a difference with even a minimal intervention (less than 2 minutes) Barriers to referring patients to tobacco cessation counseling include: – Physician attitudes and behaviors – Financial burden for patient – Scarce resources at the practice level

7. Goal and Approach Goal: To change clinical culture and practice patterns to ensure that every patient being treated for cancer who uses tobacco is identified, advised to quit, and offered scientifically sound treatments Approach: MOQC is collaborating with the Michigan Cancer Consortium and Michigan Department Community Health to implement a standard process within participating oncology practices to automatically refer cancer patients who smoke to the free Michigan Tobacco Quitline

8. Measure of Success Percent of target population with tobacco use STATUS DOCUMENTED in the medical record TARGET: 100% Percent of tobacco users with REFERRALS to Michigan Tobacco Quitline (or other program) DOCUMENTED in the medical record TARGET: 90%

9. Results to Date – Pilot Group Data Source: Michigan Tobacco Quitline

10. 2. Future State

11. Future State

12. Michigan Tobacco Quitline Services Program is free and confidential for the patient Open 7 days per week, 7am-1am ET All Quitline coaches are highly trained in Motivational Interviewing and Behavior Modification Provides: - Referrals to local programs - Counseling - Unlimited reactive calls for one year - Self-help materials - Text messaging - Online program

13. Michigan Tobacco Quitline Eligibility

14. Michigan Tobacco Quitline Process TimingAction Day one (initiated by participant) Participants call or are referred to the MI Tobacco Quitline Tobacco cessation specialist will likely conduct intake and first of four coaching sessions Within 5 days of enrolling Participant receives welcome letter and self-help workbook If participant completes first coaching call, 1 st shipment of Nicotine Replacement Therapy (NRT) is sent out at this time Over next 6 to 8 weeks Tobacco cessation specialist conducts three remaining coaching sessions as outbound calls to participant At any timeParticipants call Michigan Tobacco Quitline for support Program completion Participant receives completion certificate after 4 coaching calls Participants will receive a follow up call at 3/6/12 months after intake to determine their quit status

15. Use only the pre-populated form provided by MOQC to ensure proper data tracking Provider signature NOT required unless patient has one of three listed conditions Patient signature and initials NOT required Instruct patient to expect a call from the Quitline: 1-800-QUIT-NOW (784-8669) Quitline Fax Referral Process

16. Patient should expect call from the Quitline: 1-800-QUIT-NOW (784-8669) Patient is called within 24 hours of receipt or based on the preferred times indicated by the participant 3 attempts to reach the patient based on the preferred times indicated on the fax referral form If no preferred times are indicated, patient is called at 24 hours, 3 days, and 10 days

17. Quitline Process: Office Follow Up Providers will receive fax back updates on patient’s progress with the Quitline: 1. Fax Received (within 48 hours) 2. Enrolled 3. NRT Ordered 4. Program Complete 5. Declined to Enroll 6. Unreachable Updates dependent on complete information on fax referral form BEST PRACTICE: Update medical record in standard location or image Quitline status faxes into record so staff can provide appropriate patient support at return visit

18. 3. Change Packet

20. 4. MOQC Resources

22. Resource Tool Kit

23. 5. Next Steps

24. Go Live Date Our practice will go live on: ____________________

25.  Accountability is defined by role  Buttons worn; brochures visible  Auto Referral (Opt Out) Process: All patients in target population who use tobacco will be referred to the Michigan Tobacco Quitline (patients have to actively opt out)  Staff show empathy & support – personal triumphs shared with patients  Staff engage families in the quit process Tips for Success!

26. Tobacco Cessation Demonstration Project: Voice of the Customer

27. ASK ADVISE REFER CC-MOQC-TEAM@med.umich.edu www.moqc.org MOQC is a Blue Cross Blue Shield of Michigan funded quality initiative Thank You!