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Practice-Based Referrals to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders

¹ Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Mich
² Department of Statistics and Probability, Michigan State University, East Lansing, Mich
³ Center for Health Care Quality and Evaluation Studies, Blue Cross Blue Shield of Michigan, Detroit, Mich

CORRESPONDING AUTHOR: William C. Wadland, MD, MS Department of Family Medicine College of Human Medicine B-106 Clinical Center East Lansing, Michigan 48824-1313 wadland{at}msu.edu

PURPOSE We undertook a study to assess the impact of comparative feedback vs general reminders on practice-based referrals to a tobacco cessation quit line and estimated costs for projected quit responses.

METHODS We conducted a group-randomized clinical trial comparing the impact of 6 quarterly (18 months) feedback reports (intervention) with that of general reminders (control) on practice-based clinician referrals to a quit-line service. Feedback reports were based on an Achievable Benchmark of Care approach using baseline practice, clinician, and patient survey responses, and referrals per quarter. Comparable quit responses and costs were estimated.

RESULTS Three hundred eight clinicians participated (171 family medicine, 88 internal medicine, 49 obstetrics-gynecology) from 87 primary care practices in Michigan. After 18 months, there were more referrals from the intervention than from the control practices (484 vs 220; P <.001). Practice facsimile (fax) referrals (84%, n = 595) exceeded telephone referrals (16%, n = 109), but telephone referrals resulted in greater likelihood of enrollment (77% telephone vs 44% fax, P <.001). The estimated number of smokers who quit based on the level of services utilized by referred smokers was 66 in the feedback and 36 in the gentle reminder practices.

CONCLUSION Providing comparative feedback on clinician referrals to a quit-line service had a modest impact with limited increased costs.

Key Words: Feedback • directive counseling/telephone • referral and consultation • smoking cessation

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