Given the significance of tobacco-related disease, it is surprising that reliable and granular measures of tobacco treatment are not made widely available. NCQA has developed and implement highly successful measures for quality in healthcare (HEDIS) and publishes an annual report that reflects the health status of tens of millions of people with health insurance. The cancer screening, diabetes management, vaccination rates, and many others have been tied to financial incentives by health insurers. In turn, CMS (Medicare Advantage), state governments and employers reward high performing health plans with financial incentives and membership. The HEDIS measures and related incentives have transformed medical practice and improved public health. NCQA has relied on a different measurement tool that surveys a small number of health plan members (usually 200-400) about their recollection of tobacco treatment. Given the relatively low prevalence of tobacco use (19%) the data generated was not sufficiently robust to provide feedback at the level of a medical group or individual practitioner.

The absence of a widely available process or outcome measure has damaged progress in reducing the prevalence of tobacco use.

What can you do now?

I am recommending adoption of quality improvement plans at the medical group or health system level that include measures adopted from Healthy People 2030:

Prevalence of tobacco use depends on a reliable process of collecting this information on every adult. In addition to the measures listed, consider adding greater specificity to tobacco use to include e-cigarettes and pouches.

Treatment of tobacco use includes counseling, referral for counseling and prescription medication. These processes can be captured in the EMR.

Treatment outcomes can be verified by two consecutive office visits with a tobacco use status that is changed. A shift from cigarette smoking to vaping is considered a partially successful intervention.

Details on metrics for measurement are available here

What to do with all this data

Feedback loops are essential for the success of a quality improvement program. All clinicians and practice settings should receive feedback on performance relative to their peers.