April 26, 2011

NC Prevention Partners is a nonprofit organization based in North Carolina that is doing some interesting and successful work in tobacco cessation and other health issues that affect preventable death and disease.  Since 1998 NC Prevention Partners has accumulated a list of accomplishments starting with a voluntary insurance reform campaign to have health insurance plans cover preventive health services.  They also played a critical role in advocating for dedicated health and wellness funds from North Carolina’s tobacco settlement with the tobacco industry.  ActionToQuit recently spoke with Melva Fager Okun, DrPH, Senior Program Manager with NC Prevention Partners. Dr. Okun manages the Healthy NC Hospitals Initiative. She helped North Carolina hospitals develop and implement 100% tobacco-free campus wide policies. North Carolina hospitals led the nation in this initiative. Dr. Fager Okun is currently working with hospital leaders to increase their support for hospital employees and patients to quit the use of tobacco.

ActionToQuit:

Please tell us a little about your organization.

NC Prevention Partners:

NC Prevention Partners (NCPP) is a statewide nonprofit that has been working for 13 years to reduce preventable illness and early death caused by tobacco use, poor nutrition and physical inactivity.  Our work brings together leaders from business, health insurers, schools, hospitals, foundations, researchers, consumers, public health and advocacy organizations to improve health and control costs.

We have teams that work with hospitals, schools, state government, and large and small businesses.

ActionToQuit:

Please tell us about your work to reduce tobacco use.

NC Prevention Partners:

My work with North Carolina hospitals is funded by The Duke Endowment.  We had a three-year grant that ended in 2009 that was used to protect visitors, patients, and staff in hospitals from exposure to second hand smoke.  We have achieved 100% tobacco-free campuses in all our hospitals—the first state to do so.

The implementation of tobacco-free hospital campuses took about a year at each hospital.  Part of this implementation process was to be sensitive to the needs of those people who could no longer use tobacco in and around the hospital.  Most hospitals adopted policies that stated that employees could only use tobacco by clocking out and leaving the campus on their unpaid meal breaktime. The new hospital policy was “not on my time, not on my dime.”  In other words, when employees were on the “clock” they could not use tobacco. But they were offered resources to help them cope and successfully quit.  And many made use of this opportunity. For instance, at Duke University Hospitals, about 1000 employees asked for medication to help them quit.  At the time that the hospital went tobacco-free, the medications were offered at no cost and many employees went on to successfully quit. Tobacco-free employees are more productive and their medical expenses are lower as a result.

NCPP extensively promotes the fax referral to the state’s quitline. Fax referrals to the quitline are so valuable that we have set up challenges for hospitals to compete in making the largest number of referrals.  The winning hospitals are honored with awards and media recognition.  One administrator at Wake Forest Baptist Medical Center was concerned about the minimum referrals from his hospital, and also wanted to win the Challenge, that he put goals for referrals in his annual performance review.  He set a goal of 15 per month and they achieved 127 per month within a few months of his setting and sharing his performance objective with his staff.

In the time running up to the month of greatest interest in quitting smoking—January, when people try to start the year right—executives have written letters encouraging quitting and praising those who have done so.  This is also a time when co-pays for medications are reduced or eliminated to encourage their use.

ActionToQuit:

You have an assessment that employers can use to evaluate their wellness policies, benefits, and environments for tobacco, nutrition, and physical activity.  How were the tobacco questions developed and how are they used?

NC Prevention Partners:

This assessment is part of our WorkHealthy AmericaSM tool, an executive level planning tool for wellness.  Over ten years, we have looked at the literature on tobacco use, nutrition, physical activity, and a culture of wellness to see what policies work.  Specific to tobacco, we know that tobacco free environment policies, systems approach, benefits, incentives, and evaluations are essential.  The assessment helps employers, such as hospitals, identify specific areas needing improvement.  The systems approach includes identifying tobacco users, tracking their progress and following up with them.

On the patient side, we look at how the hospital works with patients who use tobacco.  We are looking for ways to have all the resources out there work together and reinforce each other. The Patient Quit Tobacco System web-based tool also provides assessment, implementation and evaluation components. This assesses how rigorous and robust the hospital’s system approach is to tobacco cessation for its patients. We have updated it to be consistent with the upcoming Joint Commission Measure Set on Tobacco Screening and Follow Up and with Meaningful Use. 

The Joint Commission’s voluntary performance measures to address the assessment and treatment of tobacco use and dependence for all hospitalized patients will be published next year. These would be applicable to all hospitalized patients, 18 years of age or older, with a history of tobacco use at any time during the year prior to hospital arrival. 

The Meaningful Use initiative under the American Recovery and Reinvestment Act of 2009 specifically mandates that incentives are given to eligible hospitals and providers through CMS for ‘meaningful use’ of the electronic medical records.  In the First Stage of Meaningful Use, hospitals must inquire about and record tobacco use status for 50% of their patients at 13 years of age and above and, in Stage Two, they are expected to screen 80% of that group. Hospitals in compliance will be reimbursed at a minimum of $2 million.

Our webinar providing an update on the Joint Commission’s activity was held on April 19 and will be archived at the NC Prevention Partners Website in the Healthy NC Hospitals section. On July 19th, we will conduct a webinar with the CDC on Meaningful Use and how it applies to tobacco screening.

ActionToQuit:

According to your NC Prevention Report Card, which grades North Carolina on how well it supports residents in being healthy, NC has made great strides in tobacco.  How was this done?

NC Prevention Partners:

Proudly enough, we are the first state to achieve 100% tobacco-free hospital campuses and the first Southern state to pass a state law requiring our bars and restaurants be smoke-free.  Our school districts are all tobacco-free campus wide, not just in the buildings, and this impacts all activities on school grounds 24/7.  A lot of this progress was accomplished synergistically.  Schools and hospitals worked together to go tobacco-free in the community.  My work has been very generously funded by The Duke Endowment and in partnership with the NC Hospital Association. In many communities the school district led the way and, in others, the hospital took the lead. But they definitely worked together to make this dramatic change possible. Then the push moved into local governments, with community support.  Several commented that we were able to pass a tobacco-free bars and restaurants law because the hospitals and schools had already led the way. We have made a lot of progress, but unfortunately our tobacco tax is still low. That is our next major challenge – to bring our tax of $.45 up to the national average of $1.45.

ActionToQuit:

One aspect of your quit tobacco system for hospitals that seems quite important is the CEO commitment.  What is this?

NC Prevention Partners:

We consider the CEO commitment a vital part of system change in a hospital.  We ask that the chief executive sign a commitment to establish a corporate culture of wellness for hospital employees, patients, and visitors.  It shows involvement at the highest level of the hospital.  It requires that the CEO “talk and walk” wellness.  This is
mostly geared toward the employee side of hospital wellness but the concept also includes a commitment to patient health. With the Meaningful Use funds available that include a requirement to do tobacco screening, coupled with the new Joint Commission Measure Set on Tobacco Screening and Follow Up, I’ve seen an increase in interest in working with all tobacco-using patients.

ActionToQuit:

What is new on your horizon?

NC Prevention Partners:

We have a three-year grant to work with the South Carolina hospitals to do something similar to what we are doing here in North Carolina – addressing tobacco cessation, nutrition, physical activity and creating a culture of wellness.  And we have another grant from the New York City health department to work with NYC hospitals to go 100% tobacco-free campus wide and to enhance efforts to support all hospital employees and patients to quit the use of tobacco. I’m headed up to NYC next week and look forward to it!