Specifications Manual for Joint Commission National Quality Measures (v2020A)
Posted: August 1, 2019
Discharges 01-01-20 (1Q20) through 6-30-20 (2Q20)

Release Notes:
Measure Information Form
Version 2020A

Measure Information Form

Measure Set: Tobacco Treatment Measures (TOB)

Set Measure ID: TOB-03

Performance Measure Name: Tobacco Use Treatment Provided or Offered at Discharge

Description: The measure is reported as an overall rate which includes all patients to whom tobacco use treatment was provided, or offered and refused, at the time of hospital discharge, and a second rate, a subset of the first, which includes only those patients who received tobacco use treatment at discharge. The Provided or Offered rate (TOB-03) describes patients identified as tobacco product users within the past 30 days who were referred to or refused evidence-based outpatient counseling AND received or refused a prescription for FDA-approved cessation medication upon discharge. The Tobacco Use Treatment at Discharge (TOB-03a) rate describes only those who were referred to evidence-based outpatient counseling AND received a prescription for FDA-approved cessation medication upon discharge as well as those who were referred to outpatient counseling and had reason for not receiving a prescription for medication. Those who refused are not included.

Rationale: Tobacco use is the single greatest cause of disease in the United States today and accounts for more than 435,000 deaths each year.1, 2 Smoking is a known cause of multiple cancers, heart disease, stroke, complications of pregnancy, chronic obstructive pulmonary disease, other respiratory problems, poorer wound healing, and many other diseases.3 Tobacco use creates a heavy cost to society as well as to individuals. Smoking-attributable health care expenditures are estimated at $96 billion per year in direct medical expenses and $97 billion in lost productivity.4

There is strong and consistent evidence that tobacco dependence interventions, if delivered in a timely and effective manner, significantly reduce the smoker's risk of suffering from tobacco-related disease and improved outcomes for those already suffering from a tobacco-related disease.5-12 Effective, evidence-based tobacco dependence interventions have been clearly identified and include clinician advice, individual, group, or telephone counseling, and use of the seven FDA-approved medications. These treatments are clinically effective and extremely cost-effective relative to other commonly used disease prevention interventions and medical treatments. Hospitalization (both because hospitals are a tobacco-free environment and because patients may be more motivated to quit as a result of their illness) offers an ideal opportunity to provide cessation assistance that may promote the patient's medical recovery. Patients who receive even brief advice and intervention from their care providers are more likely to quit than those who receive no intervention. Studies indicate that the combination of counseling and medications is more effective for tobacco cessation than either medication or counseling alone, except in specific populations for which there is insufficient evidence of the effectiveness of the FDA-approved cessation medications. These populations include pregnant women, smokeless tobacco users, light smokers, and adolescents. Tobacco dependence should be viewed as a chronic disease. The treatment of this chronic disease is most effective when the initial interventions provided in the hospital setting are continued upon discharge to other care settings.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement:
TOB-03: The number of patients who were referred to or refused evidence bassed outpatient counseling AND received or refused a prescription for FDA-approved cessation medication at discharge.

TOB-03a: The number of patients who were referred to evidence-based outpatient counseling AND received a prescription for FDA-approved cessation medication at discharge.

| * | *TOB-03 | TOB-03a | | Included Population | Patients who refused a prescription for FDA-approved tobacco cessation medication at discharge
Patients who refused a referral to evidence based outpatient counseling | Not Applicable | | Excluded Population | Smokeless tobacco users
Pregnant smokers
Light smokers
Patients with reasons for not administering FDA-approved cessation medication | Smokeless tobacco users
Pregnant smokers
Light smokers
Patients with reasons for not administering FDA-approved cessation medication |
Included Populations:

Excluded Populations:

Data Elements:

Denominator Statement: The number of hospitalized inpatients 18 years of age and older identified as current tobacco users.
Included Populations: Not applicable

Excluded Populations:
  • Patients less than 18 years of age
  • Patients who are cognitively impaired
  • Patients who are not current tobacco users
  • Patients who refused or were not screened for tobacco use status during the hospital stay
  • Patients who have a duration of stay less than or equal to one day and greater than 120 days
  • Patients who expired
  • Patients who left against medical advice
  • Patients discharged to another hospital
  • Patients discharged to another health care facility
  • Patients discharged to home for hospice care
  • Patients who do not reside in the United States

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal and other ICD-9-CM diagnoses which require retrospective data entry.

Data Accuracy: Data accuracy is enhanced when all definitions are used without modification. The data dictionary should be referenced for definitions and abstraction notes when questions arise during data collection.

Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: Hospitals may wish to identify those patients that refused either counseling or medications or both at discharge so as to have a better understanding of which type of treatment was accepted or refused so that efforts can be directed toward improving care.

Sampling: Yes. For additional information see the Population and Sampling Specifications section

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References: 1. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000-2004. Morbidity and Mortality Weekly Report (MMWR) 2008. 57(45): 1226-1228. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm-/.

2. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993 Nov 10;270(18):2207-12.

3. U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

4. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2007. Atlanta, GA, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2007.

5. U.S. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.

6. Baumeister SE, Schumann A, Meyer C, et al. Effects of smoking cessation on health care use: is elevated risk of hospitalization among former smokers attributable to smoking-related morbidity? Drug Alcohol Depend. 2007 May 11;88(2-3):197-203. Epub 2006 Nov 21.

7. Lightwood JM. The economics of smoking and cardiovascular disease. Prog Cardiovasc Dis. 2003 Jul-Aug;46(1):39-78.

8. Lightwood JM, Glantz SA. Short-term economic and health benefits of smoking cessation: myocardial infarction and stroke. Circulation. 1997 Aug 19;96(4):1089-96.

9. Rasmussen SR, Prescott E, Sorensen TI, et al. The total lifetime health cost savings of smoking cessation to society. Eur J Public Health. 2005 Dec;15(6):601-6. Epub 2005 Jul 13.

10. Hurley SF. Short-term impact of smoking cessation on myocardial infarction and stroke hospitalizations and costs in Australia. Med J Aust. 2005 Jul 4;183(1):13-7.

11. Critchley J, Capewell S. Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev. 2004;(1):CD003041.

12. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007 Jun 7;356(23):2388-98.

13. Fiore MC et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

14. U.S. Department of Health and Human Services: The health benefits of smoking cessation: a report of the Surgeon General. Publication No. (CDC) 90-8416. Rockville, MD: U.S. Department of Health and Human Services, 1990.

15. Rigotti NA, Munafo MR, Stead LF. Smoking cessation interventions for hospitalized smokers: a systematic review. Arch Intern Med. 2008 Oct 13;168(18):1950-60.

Measure Algorithm:

TOB03_pg1

TOB03_pg2

TOB03_pg3

Measure Information Form TOB-03
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Specifications Manual for Joint Commission National Quality Measures (v2020A)
Discharges 01-01-20 (1Q20) through 6-30-20 (2Q20)

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