Instituting Change in a Large HMO: Tobacco Cessation

Purpose: Discuss the experience of a large HMO in integrating a comprehensive approach that facilitates lifestyle behavior change using tobacco cessation as a model.

Background: Tobacco remains the leading cause of death in the United States (American Lung Association, 2005). Kaiser Permanente Southern California sought to increase the number of members who quit smoking. Utilizing the knowledge of Adult Learning Theory, Stages of Change, and Social Learning Theory, a multifaceted approach was created to facilitate behavior change through physician intervention, integration of a variety of health education resources, partnership with the health care team, and integration into electronic systems. The model addresses barriers to implementation common to large organizations.

Method: The model includes ten elements to facilitate organizational commitment and integration of tobacco cessation: (1) evidence-based interventions, (2) organizational readiness and support, (3) passionate champions, (4) quality education resources, (5) employees/physicians to model desired behavior, (6) integration into systems, (7) integration into operations, (8) communication strategies, (9) performance metrics, and (10) evaluation/lessons learned.

Results: Although knowledge and resources are essential to behavior change, it is critical to embed awareness and access to services through the patients' experience. The presentation will discuss the elements of the model, the cyclical nature of the model, and the model's influence in improving impact and outcomes.