Public Health Nurses Lead Policy Change in Tobacco Screening for Homecare Patients in Visiting Nurse Services in Westchester (VNSW), also serving the Bronx, Dutchess, Putnam and Rockland Counties of New York State

In 2002, 2 public health nurses identified a gap in screening patients for tobacco use in the home care population at VNSW in the lower Hudson Valley of New York State. This is significant because tobacco remains the leading cause of preventable death and costs the U.S more than $193 billion dollars per year in health care expenditures and productivity costs (CDC, 2014).

As a Medicare-certified home healthcare agency, VNS Westchester utilizes OASIS (Outcome and Assessment Information Set), a   Center for Medicare and Medicaid (CMS) data collection tool used to collect and report performance data for all Medicare and Medicaid home healthcare patients. The data items measured cover a range of criteria including health and functional status, support system, environment and health service utilization characteristics of the patient. The OASIS only screened patients by eliciting information if they were a heavy smoker. Many patients were not identified or provided with help to quit smoking because of OASIS screening assessment. The policy change added a co-step so that every patient was asked whether they smoked, the frequency and whether they were interested in quitting. The 5 A’s model (American Lung Association)  was used in assessing every patient who self-reported or family member or the nurse made an assessment based on evidence of environmental tobacco smoke. The Agency for Healthcare Research and Quality framework (2008) utilization has resulted in a change in culture and sustainable policy. Since 2002, more than 84,000 patients have been screened as a result of this policy change.