CS254056-A

Louisiana State University Health System’s
 

Tobacco Control Initiative
 

Background 

The Louisiana State University (LSU) Health System is one of the largest safety-net health care delivery systems in the 

country, serving hundreds of thousands of Louisiana residents. In addition to attending physicians and nurses, more 

than 1,100 medical residents and fellows provide care at the 10 facilities comprised by this integrated system.1

 Two 

distinct institutions operate hospitals within the LSU health system: the Health Care Services Division (HCSD) of the 

LSU Health Sciences Center-New Orleans (LSUHSC-New Orleans) operates seven hospitals in the southern part of the 

state, and the LSU Health Sciences Center-Shreveport (LSUHSC-Shreveport) operates three hospitals in the northern 

part of the state. All facilities serve as training sites for LSU medical, nursing, and allied health students.2

 During 2011, 

the LSU Health System recorded more than 66,000 inpatient admissions and 2.1 million outpatient visits; 29% of all 

primary care outpatients in the HCSD system were smokers, 65% were women, 53% were African-American, and 42% 

were uninsured.2 

In 2002, the HCSD and LSUHSC-Shreveport partnered with the LSUHSC-New 

Orleans School of Public Health to establish the Tobacco Control Initiative 

(TCI). The TCI’s goal was to reduce tobacco use among the patient population 

of the 10 LSU health system public hospitals. The initiative was created as part 

of a statewide tobacco control program funded by a legislatively enacted 

cigarette excise tax. By using a health systems change approach, evidencebased clinical interventions and treatments were integrated into patient care 

practices at all 10 sites. 

The TCI is an example of a real-world implementation project with a research 

component. Results of the health systems approach work at LSU health system 

public hospitals and its effects have been recently published. 2, 3, 4, 5, 6, 7 This 

question and answer (Q&A) with the TCI management team provides state 

tobacco control programs with additional details about how the TCI team 

developed and implemented this systems approach among their hospitals, as 

well as outcomes they have seen from their work. 

Question 1: What was the impetus for the LSU Health System’s 

Tobacco Control Initiative, and how did you obtain buy-in 

from the 10 hospitals? 

Answer: In 2002, the Louisiana State Legislature increased the excise tax on 

cigarettes from 24 cents to 36 cents and allocated a portion of the revenue 

to a Tobacco Tax Health Care Fund to be distributed for tobacco prevention 

and cessation programs. The legislation included a mandate and funding for 

cessation services in Louisiana’s public hospital system. The LSUHSC-New 

Orleans, through its School of Public Health, received the funding to work with 

the public hospitals to design and implement the TCI. 

With this mandate, the TCI Director, a faculty member in the School of Public 

Health, worked with hospital system administrators to develop a plan for 

cessation services, and started by asking, “How can we work with you?” At the 

Key Highlights 

◊ The LSU Health System’s Tobacco 

Control Initiative used a systems 

approach to integrate evidencebased tobacco treatment 

into routine care at 10 public 

hospitals. 

◊ This Q&A provides state tobacco 

control programs with details 

about the program design, 

implementation, outcomes, and 

learnings. 

◊ Key learnings from this health 

systems change project include 

the following: 

1.Trained and motivated staff are 

critical to success. 

2.When implementing systems 

changes, practice the 3 

P’s—practical strategies, 

persistence, and patience. 

3.When measuring success, 

conceptualize and 

communicate what the wins 

are for intervention adoption 

for the system, clinicians, and 

patients. 

National Center for Chronic Disease Prevention and Health Promotion 

Office on Smoking and Health 
time, seven facilities under the auspices of the LSUHSC-New Orleans were developing a chronic disease management 

program focused on coordinating services to improve the health outcomes of patients with chronic conditions. It was 

felt that a tobacco control initiative could align with the disease management program, which offered a point of access 

to an existing organizational structure, protocol-driven clinical care, information technology for patient tracking, and 

the potential for performance feedback and program evaluation.7 

Interviews were conducted with hospital administrators to assess the following: (1) knowledge of US Public Health 

Service Guideline Treating Tobacco Use and Dependence (PHSG) recommendations; (2) existing cessation services; and 

(3) each hospital’s needs. These interviews were critical for securing buy-in and guiding the TCI systems design. Chief 

among the needs cited by hospital administrators was a coordinator dedicated to tobacco cessation services, which the 

TCI management team subsequently provided as part of the program. 

Although the hospitals received no direct funding, we identified multiple wins, or benefits, from the TCI in the form of 

systems modifications, extensive training, evidence-based cessation treatment services, and the dedicated tobacco 

treatment staff on-site. The TCI Director also participated in system-sponsored activities, including quarterly systemwide Health Care Effectiveness Forums (attended by administrators, physicians, nurses, patient and clinician educators, 

and quality assurance staff ) and meetings of the Clinical Care Coordination team (i.e., clinical leads for each disease or 

risk factor). 

Question 2: What are the goals of the LSU Health System’s Tobacco Control Initiative? 

Answer: We formulated three project goals: (1) to identify all tobacco users; (2) to identify evidence-based 

interventions that are both appropriate for and acceptable to patients served by the hospitals; and (3) to evaluate 

implementation and performance of the 5As continuously to guide program development and improve adherence and 

outcomes. 

We then set numeric performance goals on process measures at the system, clinician, and patient levels by using 

literature available at the time.5, 8 The TCI adopted quantitative cessation goals from the 2002 National Blueprint for 

Disseminating and Implementing Evidence-Based Clinical and Community Strategies to Promote Tobacco-Use Cessation, a 

document developed by a consortium of public and private agencies committed to tobacco control.9 

•	 At the system level, our goals were to implement electronic identification and documentation of tobacco use 

status and treatment in all 10 facilities, and to train providers across all facilities to conduct evidence-based 

tobacco treatment interventions. 

•	 At the clinician level, our goals were to (1) have physicians ask 100% of their patients about tobacco use; (2) 

advise 90% of identified tobacco users to quit; (3) assess 90% of identified tobacco users for readiness to quit; 

(4) assist 75% of identified tobacco users who say they are ready to quit in a quit attempt by using behavioral 

counseling and/or medication; and (5) arrange follow-up contact for 50% of tobacco users who make a quit 

attempt. 

•	 At the patient level, our goals were to have 40% of tobacco users use evidence-based treatment (medications, 

in-house behavioral counseling, and/or quitline services), and to increase the annual quit rate to 10%.5 

Despite the complexity of the LSU health system, we made significant progress toward meeting these goals within 3 

years of integrating the 5As protocol into the electronic health record (EHR). 

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Question 3: What principles or research guided the development of the TCI for this large 

public hospital system? 

Answer: The PHSG served as the foundation for the TCI clinical intervention protocol, although systems-thinking 

guided our framework for program conceptualization and development. We invited experts to describe systemsthinking approaches, although in 2002, we were clearly an early adopter of putting systems-thinking into action. Later, 

publications, such as the National Cancer Institute Monograph 18: Greater Than the Sum: Systems Thinking in Tobacco 

Control (2007), reinforced our systems orientation.10 

In addition, we realized we had to think systemically to accomplish our goals. With multiple facilities each having 

multiple different processes and data collection systems, we needed systems-wide approaches to enable them all to 

move in the same direction. To make this happen, we identified (1) common processes of care among all facilities; (2) 

existing data sources shared by facilities; and (3) data collection and retrieval processes available to all facilities. On the 

basis of these findings, we developed tracking and surveillance systems to work in tandem with the health system’s 

web-based evaluation reporting tool for documenting program performance. 

In many respects, our TCI as a systems initiative was ahead of its time; it predated the CDC Practical Guide for Working 

with Health Care Systems (2006),11 the Partnership for Prevention and CDC Healthcare Provider Reminder Systems, 

Provider Education, and Patient Education: Working with Healthcare Delivery Systems to Improve the Delivery of TobaccoUse Treatment to Patients—An Action Guide (2008)12, the Affordable Care Act (2010), and the ARRA/HITECH Act (2009), 

which authorized the CMS Meaningful Use Incentive Program, which, in turn, accelerated adoption of electronic 

health records. 

Question 4: What were the chief clinical intervention and treatment components of 

the program? 

Answer: The components of the TCI include systems to (1) identify tobacco users; (2) perform routine, evidence-based 

cessation clinical interventions; and (3) offer patients several treatment options, which are described briefly here. The 

TCI also provides dedicated tobacco treatment personnel at each site, clinician training, and routine performance 

appraisal and feedback. 

•	 Tobacco use identification and registry: Before having an electronic health record system (EHR), we used 

a process to identify all tobacco users during hospital registration and financial certification (required every 

180 days). Administrative staff asked all patients, “Have you used tobacco in the past 30 days?” From this step, 

we were able to create a tobacco registry that served, in the early days, as the denominator of all tobacco 

users—essential for analytic and program evaluation purposes. Later, we integrated tobacco identification into 

the EHR. Tobacco use status is now documented during the nursing assessment; the “ask” (i.e., screening) is 

electronically prompted if an assessment has not been conducted during the past 90 days. 

•	 Electronic-supported clinical interventions: We designed a comprehensive system of clinical 5A 

interventions, shown in Figure 1. In 2006, the first iteration was integrated into HCSD’s EHR, Clinical Inquiry 

(CLiQ)—an internally developed LSU Health System EHR, as shown in Figures 2.1 and 2.2.7

 CLiQ provided all 

the functionality we associate today with EHRs; it provided clinicians with a centralized entry point to organize 

patient data from multiple sources and was used in 8 of the 10 hospitals. 

•	 Treatment options: To support clinical interventions, our TCI design included referrals to the state quitline 

service, low or no cost medications, free group behavioral counseling at each hospital, and patient follow-up 

by phone and mail. As shown in Figure 2.1, an EHR screen prompts clinicians to select one or more treatment 

options, which are then arranged by TCI staff (e.g., make quitline referral, schedule and conduct on-site group 

counseling, and provide NRT). TCI staff also provide bedside consults for hospitalized smokers. The TCI staff 

at all 10 facilities use a standardized relational database to track the treatment process (e.g., patients referred, 

contacted, scheduled). With this database, we can identify areas for improvement.8 

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Figure 1. The TCI Clinical Protocol, Version 3 

Figure 2.1. CLIQ EHR Screen Shot—Tobacco 5A Intervention 

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Figure 2.2. CLIQ EHR Screen Shot—Pop-Up Summary of Patient Quit Status 

Question 5: How did you get the initiative off the ground, and what problems did you 

encounter? 

Answer: Starting in 2002, we entered into a 2-year data gathering and planning period, shown in Figure 3. A first step 

was for the TCI team to conduct surveys with administrators at each facility to identify both common and unique 

practices and policies, and with facility directors to identify needs and barriers, (as previously described in question 1). 

In 2005, we also surveyed patients to learn about tobacco use prevalence and patterns, quitting behaviors, and patient 

treatment preferences. See Figure 3 for the TCI project timeline.5 

Figure 3. TCI Project Time 

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In 2005, we also completed a pilot of our care model and clinical processes and made modifications. We then phased a 

roll-out across all facilities in 2005 and 2006.8

 At the same time, we hired and trained the TCI staff—up to three per site, 

and established a tobacco control team at each site consisting of nurses, physicians, patient educators, representatives 

from social service departments, and other potential champions. We developed a multilayered training program for 

the TCI-funded site coordinators and for the other health care professionals in the LSU health system. In response 

to needs identified by administrators, we placed the TCI staff at each site to do significant pieces of work, thereby 

reducing both administrative and clinician burden. Specifically, the TCI staff sought to identify influential stakeholders, 

coordinate clinic integration, conduct clinician and clinic staff training, and arrange cessation services for all referred 

patients ready to quit within 30 days. 

Hospital administrators were largely unaware of the legislative mandate behind the TCI; thus, it was not a factor in 

achieving buy-in. Rather, to gain cooperation, we focused on a win-win-win approach. We integrated the tobacco 

cessation initiative into existing processes of care through the chronic disease program underway among all hospitals 

in the system, achieving a win for the TCI; we made evidence-based treatment of tobacco use available as standard 

care for all patients at low or no cost, achieving a win for patients; and we helped facilities meet accreditation and 

recognition from a variety of organizations (e.g., Joint Commission, National Committee on Quality Assurance), a win 

for the health care delivery system. 

At the start of the program, we did not have access to patient smoking status and, thus, used paper referrals. As a 

result, patient referrals for tobacco treatment and data collection were labor-intensive. We recognized early that we 

needed an electronic system—a central entry point to enter data from multiple data sources. Consequently, the TCI 

management team took on the task of integrating tobacco user identification and interventions into the CLIQ system. 

We found ourselves implementing the TCI in a large and complex system, while we were also building the electronic 

infrastructure—a challenging set of conditions. 

By 2010, we were working on developing a third and refined version of CLIQ measures to identify tobacco users 

in clinical settings and track clinician adherence to 5A interventions. With those revisions, a clinician is now able 

to progress through each question, enter data, save, and receive a graphic of the patient responses that shows if a 

patient is smoking or has made a quit attempt during the past 90 days.6 

Question 6: With multiple sites and several thousand clinical staff, what kind of training 

was offered to support the TCI system implementation? 

Answer: Training has been a very important component of the TCI, and we have reached hundreds of clinicians 

during several years. This includes training for our TCI staff, as well as training for clinicians and clinical support staff 

throughout the LSU hospital systems. Incoming TCI treatment staff received a 6-week orientation and training on 

a range of topics—HIPAA, tobacco 101, working with special populations, motivational interviewing, and tobacco 

treatment (e.g., Freedom from Smoking program). In 2011, all TCI staff obtained Association for the Treatment of 

Tobacco Use and Dependency (ATTUD) certification as tobacco treatment specialists. 

We did in-service training with clinical staff at all sites, including presentations on the overall program, the clinical and 

EHR protocol, and how to intervene with tobacco users. To build 5A intervention skills and reach more clinicians, we 

linked our provider learning system to online tobacco treatment resources, such as the University of Wisconsin CEU 

course on the PHSG. This one-credit hour course provided us with the documentation of completion of the training. 

The certificate of completion was submitted to the education department of each facility, and a list of those who 

completed the course was provided to the TCI staff. Counting both in-person trainings and the web-based course, the 

number of clinicians receiving training increased to 934 in 2007, 1,445 in 2008, and 1,472 in 2009.5,13 To address clinical 

staff turnover, the TCI created a module that was included in training for new hires and was also offered as a refresher 

course for required clinician education. 

In 2008, the LSUHSC-NO adopted a policy requiring completion of the online course by all nurses and other staff. 

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Question 7: How did the TCI team monitor implementation and performance at the clinic 

and provider levels? 

Answer: To encourage and motivate change, clinician performance on tobacco interventions was posted regularly 

on a system-wide dashboard. Initially, the TCI performance assessments were a stand-alone program. Later, tobacco 

measures were integrated into the performance appraisal system for the disease-specific reports of the chronic 

disease management program. Facilities and clinics receive quarterly and monthly feedback reports visible to all. 

Called the “Christmas Tree” report, the feedback includes green (above average performance) and red (below average 

performance) results for indicators based on guideline adherence for each disease and modifiable risk factors (e.g., 

hypertension, tobacco use, body mass index); decreases or gaps in tobacco indicators for Assist or Arrange will trigger 

retraining by the TCI staff and tobacco control team. 

To monitor provider adherence to the TCI’s guideline-based protocol, patient surveys are conducted periodically 

to assess tobacco use, quit attempts, and perceptions of provider treatment.4

 Clinician practice patterns are also 

examined through electronic health record (EHR) queries and a survey of clinicians2

; findings and feedback are 

then provided to each specific site to improve performance. As an example, Table 1 shows the frequencies of 5A’s 

performance for all sites from a patient survey and an EHR query for January-March 2010.2

 Note: The EHR Query on 

arranged follow-up contact within 1 week or 1 month is at 100% because all tobacco users assisted with the selection 

of at least one treatment option are electronically referred to the TCI staff who conduct follow-up contacts. In contrast, 

patient reports via survey indicate lower rates of follow-up. This may be because of the patient’s interpretation of 

the question (i.e., who they consider the health care provider to be, whether or not they received advice to quit, and 

understanding that the TCI staff make follow-up contacts on behalf of the health care providers). 

Table 1. Frequencies of 5A’s Performance from TCI Patient Survey and EHR Inquiry in the LSU Health 

System among Primary Care Outpatients, January-March 2010. 

5A’s Protocol 

Frequency (%) 

Patient Survey 

2010 

EHR Query 

2010 

Asked about tobacco use. 740/820 (90.2) 39,424/48,913 (80.6) 

Advised to quit smoking. 164/192 (85.8) 11,224/11,372 (98.7) 

Assessed willingness to make a quit attempt. 136/192 (71.7) 11,224/11,372 (98.7) 

Assisted with selecting or prescribing or 

recommending a treatment option. 

124/164 (76.3) 2,183/3,220 (67.8) 

Arranged follow-up contact within 1 week 

or 1 month. 

48/164 (31.4) 2,183/2,183 (100.0)

 Abbreviations: TCI, Tobacco Control Initiative; EHR, electronic health record; LSU, Louisiana State University. 

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Question 8: What results have been achieved over time by the TCI? 

Answer: The TCI data collection allowed us to understand the prevalence of tobacco use among our primary care 

patients for the first time, whereas analyses of EHR data showed improved rates of intervention and quit rates. Quit 

rates, calculated electronically by using CLiQ data, are defined as quit after 90 days and as a sustained quit after 

another 90 days.5

 Quit rates increased from 5.0% in 2008 to 9.6% in 2009.5 14- 16 We learned from patient and EHR 

process data, retrieved and reported periodically, that progress was being made on process goals established at the 

outset. In 2011, we achieved and sustained a 90% rate of identification among all sites. Among tobacco users who 

were assessed as ready to quit, 80% were recorded as receiving assistance with treatment selection. Of these, more 

than half selected medication (54%) and group counseling (51%), whereas more than a third (38%) selected quit-line 

counseling.13 The TCI program now provides 60% of all fax referrals to Louisiana’s quitline. Patient surveys also show 

significant improvements over time in patient reports of receiving treatment and patient awareness of cessation 

services. 

Two LSU TCI studies were also conducted recently, and results have been published.2, 4 To evaluate the effect of the TCI 

5A protocol (ask, advise, assess, assist, and arrange), Moody-Thomas and colleagues conducted a prospective study 

by using data collected at 2 time points about 571 and 889 adult patients from LSU Health primary care clinics in 2004 

and 2010, respectively.4

 Patient reports indicated that provider adherence to the 5A clinical protocol increased from 

2004 to 2010 on assess (39% vs 72%), assist (24% vs 76%), and arrange (8% vs 31%). Patient-reported quit attempts 

increased, and awareness of cessation services increased (from 19% to 70%, P<0.001). 

To assess systems change within the TCI sites and the effect on quits, Moody-Thomas and colleagues completed 

a system-level analysis by using EHR data for 79,777 patients and 1.2 million adult primary care encounters from 

January 2009 through January 2012. Results were published by the American Journal of Public Health and show that 

all seven sites sustained systems change and achieved a near perfect screening rate (99.7%).17 (As might be expected, 

intervention rates extracted from the EHR differ somewhat from patient reports and are consistently higher.) During 

this study period, there was 9.5% relative decrease in prevalence of tobacco use, and each intervention (defined here 

as asked and advised) increased the relative odds of a 6-month sustained quit by 1.5%. 

Question 9: What lessons have you learned that might be helpful to others? 

Answer: 

•	 Staff are the key: Provider training and feedback are critical to making the system changes work. Our 

experience also confirmed the wisdom of one strategy—having staff within each hospital dedicated to tobacco 

control. For start-up and implementation, we had from 1 to 3 TCI staff per site or 15 in total; today, with the 

expanded use of EHRs reducing the data management burden, 6 TCI staff cover all facilities. 

•	 Practice the 3 P’s—practical strategies, persistence, and patience in implementation: Working in a large, 

complex environment, such as our public hospital system, we learned that our team needed to be practical, 

persistent, and patient. With lots of interconnected parts, synchronicity was not always possible among sites 

with implementation or clinician training. We had to be practical; we moved to implement what we could, 

when we could. At any point in time, the system (and the people in it) can revert to old routines, and our 

momentum would be lost. We used data to keep the pressure on and keep a persistent call for change. Systems 

change is gradual, and patience is required. However, once you reach a certain tipping point, progress 

accelerates, and the rewards increase correspondingly. 

•	 The “WWWs”—win-win-win—are critical to obtain and sustain buy-in: When we were getting started, we 

needed to conceptualize wins across all levels—system, clinician, and patient for treatment of tobacco use as 

an integral component of quality care. Our job is to deliver cessation treatments and integrate interventions 

into practice, systemically and electronically, so that data can be used to demonstrate health improvement and 

cost containment. 

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Question 10: What do you see as future directions for the TCI and cessation systems research? 

Answer: We need to use our data to further improve care delivery and patient quit outcomes. The data allow us 

numerous options for program refinement. For example, we are currently exploring the use of geocoding to assess 

the effect of living proximity on attendance at group behavioral counseling sessions.18 The use of geocoding makes 

it possible for TCI staff to tailor treatment options to the needs of patients. Although all options may be offered to 

all smokers, follow-up contact with those who fail to use the selected treatment may be more effective if proximity 

is used as a proxy for access, (i.e., likelihood of participating). Then, TCI staff can promote enrollment in an equally 

effective and more acceptable treatment that the patient is more likely to use (e.g., quit line versus group counseling). 

This use of our data aligns with our original goals: (1) conducting ongoing evaluation to guide program development 

and improve adherence and outcomes; and (2) identifying evidence-based interventions that are both appropriate 

and acceptable to patients served by the state hospital system. These goals are best accomplished by expanding the 

uses of our data. 

Performance partnerships are an innovative approach to increase smoking cessation.19 We will use these 

interdependent relationships and performance partnerships within the LSU health system to improve health 

outcomes for priority populations, including pregnant smokers, and to change the path to health of smokers who 

have not yet developed comorbid conditions. 

For information and practical insights, see our recent 2013 publication, Use of systems change and health information 

technology to integrate comprehensive tobacco cessation services in a statewide system for delivery of healthcare.

5 

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References 

1.	 Louisiana State University Health System. LSU health annual report. http://www.lsuhospitals.org/docs/LSU_
 

AnnualReport2010.pdf. Accessed January 7, 2015.
 

2.	 Celestin MD Jr, Hart A Jr, Moody-Thomas S. Partnering with health care systems to assess tobacco treatment practices 


and beliefs among clinicians: evaluating the process. Prev Chronic Dis. 2014;11:130277. doi: http://www.cdc.gov/pcd/
 

issues/2014/13_0277.htm
 

3.	 Tseng T, Moody-Thomas S, Horswell R, Yi Y, Celestin MD, Jones KD. Using a health informatics system to assess effect 


of a federal cigarette tax increase on readiness to quit among low-income smokers, Louisiana, 2009. Prev Chronic Dis. 


2014;11:130203. DOI: http://dx.doi.org/10.5888/pcd11.130203 


4.	 Moody-Thomas S, Celestin MD Jr, Tseng TS, Horswell R. Patient tobacco use, quit attempts, and perceptions of healthcare 

provider practices in a safety-net healthcare system. Ochsner J. 2013;13(3):367-374. 

5.	 Moody-Thomas S, Celestin MD Jr, Horswell R. Use of systems change and health information technology to integrate
 

comprehensive tobacco cessation services in a statewide system for delivery of healthcare. Open J Prev Med. 


013;03(01):75-83. DOI: http://dx.doi.org/10.4236/ojpm.2013.31010 


6.	 Thomas SM, Horswell R, Celestin MD, et al. Awareness and implementation of the 2000 United States public health service 

tobacco dependence treatment guideline in a public hospital system. Popul Health Manage. 2011;4:79-85. doi:10.1089/ 

pop.2010.0004 

7.	 Horswell R, Butler MK, Kaiser M, et al. Disease management programs for the underserved. Dis Manage. 2008;11:145-152. 

doi:10.1089/dis.2007.0011 

8.	 Moody-Thomas S. Implementing systems-level strategies in a public hospital system. Paper presented at: Emory Conference 

Center, October 28, 2010; Atlanta, GA. 

9.	 National Tobacco Cessation Collaborative. National blueprint for disseminating and implementing evidence-based clinical 

and community strategies to promote tobacco-use cessation. University of Wisconsin, Center for Tobacco Research and 

Intervention, October, 2002. Madison, WI. http://www.tobacco-cessation.org/PDFs/blueprint_adult.pdf. 

10. National Cancer Institute, Monograph 18: Greater than the sum: systems thinking in tobacco control. Publication number: 

T071; NIH number: 06-6085. April, 2007. http://www.cancercontrol.cancer.gov/tcrb/monographs/18/index.html. 

11. Centers for Disease Control and Prevention. A Practical Guide to Working with Health-Care Systems on Tobacco Use Treatment. 

Atlanta, GA: U.S. Department of Health and Human Services; 2006. 

12. Partnership for Prevention. Healthcare Provider Reminder Systems, Provider Education, and Patient Education: Working with 

Healthcare Delivery Systems to Improve the Delivery of Tobacco-Use Treatment to Patients—An Action Guide. The Community 

Health Promotion Handbook: Action Guides to Improve Community Health. Washington, DC: Partnership for Prevention; 

2008. 

13. Moody-Thomas S. The Tobacco Control Initiative: What can happen when healthcare delivery systems “Do the Right Thing.” 

Webinar presented at: The Multi-State Collaborative for Health Systems Change. March 30, 2012. 

14. Louisiana Department of Health and Hospitals, Louisiana Tobacco Control Program. Forging Ahead, Annual Report, 2010. 

http://www.latobaccocontrol.com/documents/pdf/FINAL%20revised%20version%202011-09-152.pdf. 

15. Centers for Disease Control and Prevention. Cigarette smoking among adults and trends in smoking cessation – United 

States, 2008. MMWR Morb Mortal Wkly Rep. 2008;58(44):1227-1232. 

16. Centers for Disease Prevention and Control. Vital signs: current cigarette smoking among adults aged ≥ 18 years – United 

States, 2009. MMWR Morb Mortal Wkly Rep. 2009;59(35):1135-1140. 

17. Moody-Thomas S, Horswell R, Land T, et al. Effect of Systems Change and use of Electronic Health Records on Quit Rates 

Among Tobacco Users in a Public Hospital System, Am J Public Health. In press. 

18. Tseng TS, Xiao K, Yu Q, et al. Using geographic information system (GIS) technology to access accessibility of smoking 

cessation class attendance for patients in Louisiana public hospitals. American Public Health Association 142nd Annual 

Meeting and Exposition, November, 2014. New Orleans, LA. 

19. Revell CC, Meriwether MB. Applying the performance partnership model to smoking cessation: lessons learned by the 


smoking cessation leadership center. Health Promot Pract. 2011;12(2):125S-129S.
 

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