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## Complete Summary

#### TITLE

Tobacco use prevention and cessation for adults and mature adolescents:
percentage of patients\' charts that either show that there is no
tobacco use/exposure or (if a user) that the current use was documented
at the most recent clinician visit.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Tobacco use
prevention and cessation for adults and mature adolescents. Bloomington
(MN): Institute for Clinical Systems Improvement (ICSI); 2004 Jun. 42 p.
\[46 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure assesses the percentage of patients\' charts that either
show that there is no tobacco use/exposure or (if a user) that the
current use was documented at the most recent clinician visit.

#### RATIONALE

The priority aim addressed by this measure is to improve the proportion
of patients whose current use of tobacco or exposure to tobacco smoke is
obvious in the chart at any primary care clinic encounter.

#### PRIMARY CLINICAL COMPONENT

Tobacco use/exposure

#### DENOMINATOR DESCRIPTION

Total number of patients\' charts audited (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Number of patients\' charts audited whose current tobacco status is
documented in the medical record (see the related \"Numerator
Inclusions/Exclusions\" field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Tobacco use prevention and cessation for adults and mature
    adolescents.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=5454)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

All patients visiting the practice, regardless of age

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Each day, nearly 4,800 adolescents (ages 11 to 17) smoke their first
cigarette; of these, nearly 2,000 will become regular smokers. That is
almost two million annually! Tobacco use includes all forms of
tobacco\--smoking cigarettes, cigars or pipes, as well as using snuff or
chewing tobacco.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Institute for Clinical Systems Improvement (ICSI). Tobacco use
prevention and cessation for adults and mature adolescents. Bloomington
(MN): Institute for Clinical Systems Improvement (ICSI); 2004 Jun. 42 p.
\[46 references\]

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Tobacco cessation is particularly important during pregnancy. Tobacco
cessation is also very important in those individuals with heart disease
or other risk factors for heart disease.

#### EVIDENCE FOR ASSOCIATION WITH VULNERABLE POPULATIONS

Institute for Clinical Systems Improvement (ICSI). Tobacco use
prevention and cessation for adults and mature adolescents. Bloomington
(MN): Institute for Clinical Systems Improvement (ICSI); 2004 Jun. 42 p.
\[46 references\]

#### BURDEN OF ILLNESS

Key findings regarding secondhand smoke include:

-   Secondhand smoke causes a significant number of heart attacks.

-   Secondhand smoke causes increased risk of lung cancer.

-   Secondhand smoke is a major cause of preventable heart disease.

-   Secondhand smoke causes major illness in infants. For example, an
    estimated 7,500-15,000 infants and toddlers are hospitalized with
    bronchitis or pneumonia every year because they breathe tobacco
    smoke.

-   The California Environmental Protection Agency concludes that there
    are between 22,669-69,553 cardiac deaths, between 7,564-26,473 lung
    cancer deaths, and 789,712 otitis media (ear infection) office
    visits related to secondhand smoke annually in the U.S.

#### EVIDENCE FOR BURDEN OF ILLNESS

Institute for Clinical Systems Improvement (ICSI). Tobacco use
prevention and cessation for adults and mature adolescents. Bloomington
(MN): Institute for Clinical Systems Improvement (ICSI); 2004 Jun. 42 p.
\[46 references\]

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients visiting the practice, regardless of age

**Sample Selection**

Records should be selected in a random way designed to represent a cross
section of patients of all age and gender groups seen by a clinician at
a clinic in the last month for any reason. There are various ways to
accomplish this:

1.  Use the appointment list or lists (if various specialties and
    departments are present) from a recent day or days and take every
    name (if a small list) or every 5th or 10th name (if a large list)
    until at least 50 charts have been found. Note that it is important
    to include documentation of the recent visit, so if this information
    is dictated, choose a date that will assure that the dictated record
    is back in the chart.

2.  Select charts randomly from those that are being refiled from a
    recent visit (if they contain documentation of the visit) until at
    least 50 charts have been found. These should be selected in a way
    that allows inclusion of all types of patients being seen.

3.  If charts are refiled before visit documentation is included, you
    may randomly select from the dictated notes as they are being
    prepared to be filed in the charts.

**Data Collection**

Use the Tobacco Use Status Audit Form (found in the original measure
documentation) and enter the patient\'s name or ID# and age in the
appropriate column for every chart audited until at least 50 have been
entered. In order to know exactly how to record each chart audited, use
the following definitions:

[Current Non-User]{.underline} = a label or mark anywhere on the chart
(or on general forms like a problem list) or on the most recent visit
progress note that shows that the patient has been asked at least once
and reported not using tobacco. If the patient is a child or adolescent,
a similar identification should be used to show that the child is not
exposed to smoke from a parent or guardian (i.e., if the child is
breathing the smoke of others regularly, she or he is a smoker).

[Current User]{.underline} = information at the most recent visit
progress note that shows that a user was asked about use at that visit.
This task will be simplified if the clinic uses some type of label or
general mark on the chart that shows that the patient was a user once.
However, for this category it is necessary to document at the most
recent visit just what the tobacco use is. If there is a general label
but no notation at the most recent visit, the chart should be included
in the unknown category.

[Unknown]{.underline} = either no label or mark on the chart, or a label
as a user with no documentation at the recent visit as to the current
use status.

**Analysis**

Add up all the charts that are in either the User or the Non-User
columns for the numerator. Then add to this number all of the Unknown
charts to obtain the denominator. Divide and multiply by 100 in order to
obtain the % measure.

The suggested schedule is to audit monthly until 75% identification has
been achieved. Then it is acceptable to measure only every 3 months
until 85% has been achieved, at which time yearly measures will be
satisfactory. However, whenever a measure falls below the 85% or 75%
level, the reporting frequency should revert to quarterly or monthly as
appropriate until the rate has been raised above the cutoff point
described.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Total number of patients\' charts audited\*

\*Random sample of at least 50 charts with patients of all ages who
visited a clinician within the past month

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients\' charts audited whose current tobacco status is
documented in the medical record\*

\*\"Current tobacco status documented\" means that the medical record
shows that the patient either does not use tobacco or, if a user, that
the use status was documented at the most recent visit to a clinician.
For children and adolescents, being a user includes having a parent or
guardian who smokes.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of patients\' charts that either show that there is no
tobacco use/exposure or (if a user) that the current use was documented
at the most recent clinician visit.

#### MEASURE COLLECTION

[Tobacco Use Prevention and Cessation for Adults and Mature Adolescents
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=4501)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2003 Jul

#### REVISION DATE

2004 Jun

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Tobacco use prevention and cessation for adults and
mature adolescents. Bloomington (MN): Institute for Clinical Systems
Improvement (ICSI); 2003 Jul. 36 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Tobacco use
prevention and cessation for adults and mature adolescents. Bloomington
(MN): Institute for Clinical Systems Improvement (ICSI); 2004 Jun. 42 p.
\[46 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of patients\' charts that either
show that there is no tobacco use/exposure or (if a user) that the
current use was documented at the most recent clinician visit,\" is
published in \"Health Care Guideline: Tobacco Use Prevention and
Cessation for Adults and Mature Adolescents.\" This document is
available from the [Institute for Clinical Systems Improvement (ICSI)
Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail: <icsi.info@icsi.org>

#### NQMC STATUS

This NQMC summary was completed by ECRI on March 29, 2004. This summary
was updated by ECRI on October 5, 2004.

#### COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement
\[ICSI\] Measure) is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be
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All other copyright rights in the abstracted ICSI Measures are reserved
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for Clinical Systems Improvement, Inc. assumes no liability for any
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ICSI Measures.

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Date Modified: 11/3/2008