Smoke-Free Beginnings
Oklahoma State Medical Association
Principal Investigator: Joy Leuthard, MS, LSWA
Funding period: 4/1/03-12/31/05
Background
Oklahoma ranks among the top five states for the percentage of pregnant women who smoke. Currently, one in seven low birth weight infants in Oklahoma is attributed to smoking during pregnancy. Similar to national trends, Oklahoma physicians show lower confidence in assisting patients in trying to quit smoking and in providing cessation counseling than other aspects of intervening with smoking cessation.
The Oklahoma project seeks to aide physicians in improving their abilities to delivery the Best Practice Guidelines ("5 A's") in order to increase their interventions with every smoking pregnant patient. Furthermore, since Oklahoma has a large Native American population with various health care systems aimed at meeting their health care needs, this project is provided with a unique opportunity for examining the culturally competent implementation of the Best Practice Guidelines with pregnant Native American women who smoke.
Project Partners
The Oklahoma State Medical Association and its Physicians’ Campaign for a Healthier Oklahoma (PCHO) has a history of positive working relationships with many other organizations and state agencies. Building upon this, the OSMA will partner with the University of Oklahoma, Oklahoma Physicians Research Network (OKPRN) and the Oklahoma State Department of Health (OSDH) to utilize existing infrastructures to implement this project. The network of physicians interested in quality improvement makes this organization the perfect vehicle and partner through which to implement the Smoke-Free Families Best Practice Intervention. Other partners include the Oklahoma Academy of Family Physicians, Oklahoma Foundation for Medical Quality, and the American College of Obstetricians and Gynecologists (ACOG).
Target Population of Providers
The project will recruit from a network of physicians/providers/practices that will intervene with 500-750 pregnant women over the course of the project with an added effort to recruit Native American providers and patients. Approximately 32 sites will be recruited for the study; initially four sites will serve as pilot sites to identify and resolve unforeseen barriers as well as identify materials needed in the design and implementation of the protocol for the remaining practices.
The Oklahoma State Department of Health, Tobacco Use Prevention Service is also a coordinating partner on the project. Opportunities to implement the Best Practice Guidelines in public health clinics will be explored as a result of this collaboration.
Intervention Model
This intervention is based on recommendations and implementation suggestions from ACOG and the Public Health Service Clinical Practice Guideline Treating Tobacco Use and Dependence. A “"Practice Enhancement Assistant" , or PEA, will provide education, resources, and feedback to physicians and staff at each practice regarding the plan they choose to use when implementing the "5 A's". As part of the implementation plan, physicians will be offered the use of a Personal Data Assistant (PDA) to enter information on patients to track their status at each prenatal visit. One champion will be identified in each practice who will communicate the responsibilities in the delivery of the "5 A's". Quality improvement strategies such as chart audits will be implemented to provide a fast and efficient way of modifying each part of the intervention to ensure optimal implementation at each site. The utilization of the Chronic Care Model to implement the practice guidelines will allow for an effective, efficient way to improve the health of all smoking pregnant women in Oklahoma.
Evaluation Model
Phase I of the project will focus on the development of the implementation plan and training components, the evaluation plan, as well as implementation in approximately four (4) pilot sites. These pilots will provide an opportunity to test the initial changes to the office system for each participating practice. Upon obtaining feedback from each physician, adjustments will be made to the model. In addition, focus groups will be organized to develop culturally competent materials for Native American women.
Phase II of the project will focus on full implementation of the Best Practice Intervention in approximately 30 physician practices, statewide, and in the Native American community through chart audits and pre/post measures developed by the evaluation team. Data will be collected on the attributes of the practices that successfully implement changes in physician behavior, specific components helpful in the actual implementation of the clinical guidelines, and physician and staff satisfaction with the program.
Contact:
Sarah Jane Carlson, MBA
Project Coordinator
Oklahoma State Medical Association
601 NW Grand Blvd.
Oklahoma City, OK 73118
Phone: 405-843-9571 or 800-522-9452
E-mail: carlson@osmaonline.org
Documents available for download (pdf format):
SFB Vision, Mission, Goal, Objectives
Medicaid Update
Informational presentation
Links to other internet resources:
Oklahoma State Medical Association
Oklahoma Physicians Resource/Research Network
Oklahoma State Department of Health, Tobacco Use Prevention Service
Centers for Disease Control and Prevention, Tobacco Information and Prevention Source (TIPS)
Improving Chronic Illness Care
The National Partnership to Help Pregnant Smokers Quit
Northwest AHEC Smoking Cessation Resources