National Working Group for ACTTION

July 28, 2010

A hospital stay provides a teachable moment, a time when a person should be particularly responsive to learning or being made aware of certain topics.  The Joint Commission, with funding from the Partnership for Prevention, is in the process of developing and testing a set of tobacco cessation quality standards which would take advantage of the teachable moment for hospitalized patients who smoke.

In order to comply with Joint Commission accreditation requirements, hospitals are required to collect and submit performance measure data. The proposed global set of tobacco cessation quality standards would be applicable to all hospitalized patients. The proposed measures would target all patients, 18 years of age or older, with a history of smoking cigarettes any time during the year prior to hospital arrival. If adopted, these measures will require hospitals to identify all patients who use tobacco and offer them counseling, medications and limited follow-up. The standards are intended to maximize the health of patients through improved cessation interventions. Significant increases in patients’ utilization of tobacco cessation treatments should be realized as a result.

Currently the Joint Commission has tobacco measures which only apply to a narrow patient group—those diagnosed with acute myocardial infarction, heart failure, and pneumonia—and permit great variance in compliance. For example, distribution of a smoking cessation pamphlet to patients prior to discharge has been deemed sufficient to meet the current measure.

Hospitalization can provide an ideal opportunity to deliver cessation assistance. Patients who receive even brief advice and intervention from their care providers are more likely to quit than those who receive no intervention. Partnership for Prevention believes that all hospitalized patients should have the opportunity to be assessed, offered counseling and medications, and have follow-up communication. Medical intervention works to help smokers quit and tobacco counseling is one of the most important actions medical professionals can take for their patients. Quality health care must include tobacco use treatment and hospitalization is an opportune time to assess and address tobacco use.

The current testing of the proposed measures follows a development process that began in June 2009, when a technical advisory panel was convened to construct new measures for assessing and treating tobacco and alcohol use.  These measures were posted and available for public comment during September 2009. Over 2,000 individuals and representatives from various healthcare organizations provided comments.  The comments were considered by the Technical Advisory Panel in October, 2009.  Based on both comments and panel recommendations, modifications to the measures were approved by the panel.  There are eight proposed measures, four dealing with tobacco use and four others dealing with alcohol and other drug use.

In March, 2010, a 6-month pilot-testing phase began to 1) assess the reliability of the measures and 2) obtain information about how the measures and specifications can be enhanced to provide more reliable data.  A diverse group of 26 Joint Commission- accredited hospitals, both from the private and public sector are participating in the pilot. This phase will be completed by September 2010. The Technical Advisory Panel will hold its final meeting in November. Then, the Joint Commission’s Board of Commissioners will vote on the measure set and the final report should be published by January 2011.