Tobacco use and measurement

In Minnesota and nationally, measuring tobacco use has made some important strides. Minnesota has been collecting tobacco use data from health care providers for several years on a limited basis as part of a few clinical quality measures. National organizations, including the National Quality Forum and the National Committee on Quality Assurance, also have tobacco measures. However, the snapshot provided by current data could be brought into sharper focus by expanding the scope and usage of tobacco measures.

Minnesota measures

Minnesota providers and health plans are required to report tobacco use data as part of two clinical quality measures publicly reported through MN Community Measurement:

In addition, they are asked to report tobacco use for patients with asthma and women delivering their first child.

These data represent a resource that health care systems and providers can use to assess their performance. Depending on the clinic, the rate of diabetes patients who were tobacco-free in Minnesota in 2013 ranged from 28 to 95 percent. Likewise, there was wide variation in tobacco-free status for patients with heart disease: from a low of 51 percent of patients with heart disease being tobacco-free to a high of 98 percent. That variation highlights a useful opportunity to work to reduce tobacco use in measurable ways, ultimately improving patients’ health. As we look to the future, there are also other opportunities to improve Minnesota’s tobacco measures by expanding the population of patients being measured.

National measures

Nationally, tobacco use is reported in many different ways. Smoking prevalence data for adolescents and adults are often gathered through patient surveys. Some national health care quality measures use health plan claims data. Other measures, such as those at MNCM, rely on clinics and medical groups reporting data through electronic medical records.

Of special note to providers are the implications of measuring tobacco use.

  • For example, tobacco use assessment and tobacco cessation intervention are part of the core Clinical Quality Measures under the federal Meaningful Use Stage 1 requirements, which focus on the use of certified electronic health record technology to improve population and public health, among other goals.
  • Another example is the Physician Quality Reporting System (PQRS), a voluntary reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. PQRS includes tobacco use screening, cessation and intervention as elements of its program.

More data is needed
What is lacking are data that build a complete picture of the tobacco use by patients seeking health care, as well as data that helps to spur broad-based quality improvement initiatives by measuring opportunities taken – or missed – to talk with any tobacco-using patient about quitting and directing them to the needed resources.

The U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices identified tobacco-use screening and brief intervention as one of the three highest-ranking preventive services in a study that identifies the most valuable clinical preventive services that can be offered in medical practice. The same article emphasizes making a number of changes in health care systems, including performance measurement and feedback, to help increase delivery of clinical preventive services.

Leveraging MNCM’s expertise
In Minnesota we know from direct experience that measurement is important because it can help to both drive and document improvements in health care.

For example, a 2013 New England Journal of Medicine article cites the low rate of aspirin use in the United States in secondary prevention of cardiovascular disease, despite strong evidence of its efficacy (Anand K. Parekh, M.D., M.P.H., James M. Galloway, M.D., Yuling Hong, M.D., Ph.D., and Janet S. Wright, M.D. Aspirin in the Secondary Prevention of Cardiovascular Disease. N Engl J Med 2013; 368:204-205).

In 2007, the national rate of prescribing antiplatelet medication for people with ischemic vascular disease was less than 47 percent. MNCM has an Optimal Vascular Care Measure, that includes measuring aspiring prescribing when needed. The statewide average in Minnesota for aspirin prescribing has grown steadily since we began collecting data and is now more than 95 percent.

This higher level of achievement is reflected across many MNCM measures, from blood pressure control, to Optimal Diabetes Care, to cancer screening. You can’t improve what you don’t measure. More robust measurement of tobacco use and intervention in Minnesota and nationally could help reduce tobacco use, translating into better health and increased savings.

 See more of the Spotlight on Tobacco