Measure Information Form
Version 2024B
Measure Information Form
| Set Measure ID | Performance Measure Name |
|---|---|
TOB-3  |
Tobacco Use Treatment Provided or Offered at Discharge |
| TOB-3a |
Tobacco Use Treatment at Discharge |
TOB-3 Patients identified as tobacco product users who were referred to or refused evidence-based outpatient counseling AND received or refused a prescription for FDA-approved cessation medication upon discharge.
TOB-3a Patients 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.
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-3) describes patients identified as tobacco product users 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-3a) 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 480,000 deaths each year (CDC MMWR, 2014). 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 (CDC, 2020). Tobacco use creates a heavy cost to society as well as to individuals. Smoking-attributable health care expenditures are estimated to be at least $240 billion per year in direct medical expenses for adults, and over $185 billion in lost productivity (CDC, 2022).There is strong and consistent evidence that tobacco dependence interventions, if delivered in a timely and effective manner, significantly reduce the user's risk of suffering from tobacco-related disease and improve outcomes for those already suffering from a tobacco-related disease (CDC, 2021, DHHS, 2020, Choi et al, 2021, DHHS, 2000; Baumeister, 2007; Lightwood, 2003 and 1997; Rigotti, 2012). Effective, evidence-based tobacco dependence interventions have been clearly identified and include brief clinician advice, individual, group, or telephone counseling, and use of 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.
Type Of Measure: Process Improvement Noted As: Increase in the rateTOB-3: The number of patients who were referred to or refused evidence-based outpatient counseling AND received or refused a prescription for FDA-approved cessation medication at discharge. TOB-3a: The number of patients who were referred to evidence-based outpatient counseling AND received a prescription for FDA-approved cessation medication at discharge.
Included Populations: TOB-3Denominator Statement: The number of hospitalized inpatients 18 years of age and older identified as current tobacco users.TOB-3a
- Patients who refused a prescription for FDA- Approved tobacco cessation medication at discharge.
- Patients who refused a referral to evidence-based outpatient counseling.
Excluded Populations: TOB-3 and TOB-3a
- Not Applicable
For FDA Approved Medications OnlyData Elements:
- Smokeless tobacco users
- Pregnant smokers
- Patients with reasons for not administering FDA-approved cessation medication.
Included Populations: Not applicable Excluded Populations:Data Elements:
- Patients less than 18 years of age
- Patient 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 or 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
- Patients with Comfort Measures Only documented
Variation may exist in the assignment of ICD-10 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 treatment type was accepted or refused so that efforts can be directed toward improving care. Sampling: Yes. Please refer to the measure set specific sampling requirements and 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:- Baumeister, S. E., Schumann, A., Meyer, C., John, U., Volzke, H., & Alte, D. (2007). Effects of smoking cessation on health care use: Is elevated risk of hospitalization among former smokers attributable to smoking-related morbidity? Drug and Alcohol Dependence, 88(2–3), 197–203.
- Centers for Disease Control. (2022). Smoking & Tobacco Use: Costs and Expenditures. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/cost-and-expenditures.html.
- Centers for Disease Control and Prevention. (2021). Smoking & Tobacco Use: Clinical Interventions to Treat Tobacco Use and Dependence Among Adults. https://www.cdc.gov/tobacco/patient-care/care-settings/clinical/index.html
- Centers for Disease Control and Prevention. (2020). Smoking & Tobacco Use: Health Effects. https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm
- Centers for Disease Control and Prevention. (2014). Current cigarette smoking among adults—United States, 2005–2013. Morbidity and Mortality Weekly Report (MMWR), 63(47), 1108–1112. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6347a4.htm?s_cid=mm6347a4_w.
- Choi, H. K., Ataucuri-Vargas, J., Lin, C., Singrey, A. (2021). The current state of tobacco cessation treatment. Cleveland Clinic Journal of Medicine, July 2021, 88(7), 393-404.
- Lightwood, J. M. (2003). The economics of smoking and cardiovascular disease. Progress in Cardiovascular Diseases, 46(1), 39–78.
- Lightwood, J. M., & Glantz, S. A. (1997). Short-term economic and health benefits of smoking cessation: Myocardial infarction and stroke. Circulation, 96(4), 1089–1096.
- Rigotti, N. A., Clair, C., Munafo, M. R., & Stead, L. F. (2012). Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22592676.
- U.S. Department of Health and Human Services. (2000). 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.
- United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Smoking Cessation: A Report of the Surgeon General [Internet]. Washington (DC): US Department of Health and Human Services; 2020. Chapter 6, Interventions for Smoking Cessation and Treatments for Nicotine Dependence. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555596/
Algorithm Narrative
TOB-3: Tobacco Use Treatment Provided or Offered at DischargeNumerator: The number of patients who were referred to or refused evidence-based outpatient counseling AND received or refused a prescription for FDA-approved cessation medication at discharge.
Denominator: The number of hospitalized inpatients 18 years of age and older identified as current tobacco users.
Variable key:
Patient Age
Length of Stay
1. Start processing. Run cases, which are included in the Global Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.
2. Calculate Patient Age. Patient Age, in years, is equal to the Admission Date minus the Birthdate. Use the month and day portion of Admission Date and Birthdate to yield the most accurate age. Only cases with valid Admission Date and Birthdate will pass the front-end edits into the measure specific algorithms.
3. Check Patient Age
a. If Patient Age is less than 18 years, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
b. If Patient Age is equal to or greater than 18 years, continue processing and proceed to calculate Length of Stay.
4. Calculate Length of Stay. Length of Stay, in days, is equal to the Discharge Date minus the Admission Date.
5. Check Length of Stay
a. If Length of Stay is equal to or less than 1 day, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
b. If Length of Stay is greater than 1 day, continue processing and proceed to check Comfort Measures Only.
6. Check Comfort Measures Only
a. If Comfort Measures Only is missing, the case will proceed to a Measure Category Assignment of X and will be rejected for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
b. If Comfort Measures Only is equal to 1, 2 or 3, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
c. If Comfort Measures Only is equal to 4, continue processing and proceed to check Tobacco Use Status.
7. Check Tobacco Use Status
a. If Tobacco Use Status is missing, the case will proceed to a Measure Category Assignment of X and will be rejected for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
b. If Tobacco Use Status equals 3, 4, 5, 6 or 7, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB 3a.
c. If Tobacco Use Status equals 1 or 2, continue processing and proceed to check Discharge Disposition.
8. Check Discharge Disposition
a. If Discharge Disposition is missing, the case will proceed to a Measure Category Assignment of X and will be rejected for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
b. If Discharge Disposition equals 2, 3, 4, 5, 6 or 7, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB 3a.
c. If Discharge Disposition equals 1 or 8, continue processing and proceed to check Referral for Outpatient Tobacco Cessation Counseling.
9. Check Referral for Outpatient Tobacco Cessation Counseling
a. If Referral for Outpatient Tobacco Cessation Counseling is missing, the case will proceed to a Measure Category Assignment of X and will be rejected for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB 3a.
b. If Referral for Outpatient Tobacco Cessation Counseling equals 4, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
c. If Referral for Outpatient Tobacco Cessation Counseling equals 1, 2, 3 or 5, continue processing and recheck Referral for Outpatient Tobacco Cessation Counseling.
10. Recheck Referral for Outpatient Tobacco Cessation Counseling
a. If Referral for Outpatient Tobacco Cessation Counseling equals 2 or 5, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
b. If Referral for Outpatient Tobacco Cessation Counseling equals 1or 3, continue processing and proceed to Recheck Tobacco Use Status.
11. Recheck Tobacco Use Status
a. If Tobacco Use Status equals 2, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB 3a.
b. If Tobacco Use Status equals 1, continue processing and proceed to Prescription for Tobacco Cessation Medication.
12. Check Prescription for Tobacco Cessation Medication
a. If Prescription for Tobacco Cessation Medication is missing, the case will proceed to a Measure Category Assignment of X and will be rejected for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
b. If Prescription for Tobacco Cessation Medication equals 3, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
c. If Prescription for Tobacco Cessation Medication equals 1, 2 or 4, continue processing and proceed to recheck Prescription for Tobacco Cessation Medication.
13. Recheck Prescription for Tobacco Cessation Medication
a. If Prescription for Tobacco Cessation Medication equals 1 or 2, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB 3a.
b. If Prescription for Tobacco Cessation Medication equals 4, continue processing and proceed to check Reason for No Tobacco Cessation Medication at Discharge.
14. Check Reason for No Tobacco Cessation Medication at Discharge
a. If Reason for No Tobacco Cessation Medication at Discharge is missing, the case will proceed to a Measure Category Assignment of X and will be rejected for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
b. If Reason for No Tobacco Cessation Medication at Discharge equals N, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
c. If Reason for No Tobacco Cessation Medication at Discharge equals Y, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population for the overall measure rate TOB-3. Continue processing and proceed to Step 15 to Initialize Measure Category Assignment for sub-measure TOB-3a.
Algorithm Narrative
TOB-3a: Tobacco Use Treatment at DischargeNumerator: The number of patients who were referred to evidence-based outpatient counseling AND received a prescription for FDA- approved cessation medication at discharge.
Denominator: The number of hospitalized inpatients 18 years of age and older identified as current tobacco users.
15. Initialize Measure Category Assignment for sub-measure TOB-3a to Measure Category Assignment of B. Do not change the Measure Category Assignment that was already calculated for the overall measure TOB-3. The rest of the algorithm will reset the appropriate Measure Category Assignment to TOB-3a.
16. Check Overall Rate Category Assignment
a. If the Overall Rate Category Assignment equals X, the case will proceed to a Measure Category Assignment of X and will not be in the Measure Population for the sub-measure TOB-3a. Stop processing.
b. If the Overall Rate Category Assignment equals B, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population for the sub-measure TOB-3a. Stop processing.
c. If Overall Rate Category Assignment equals D or E, continue processing and proceed to recheck Referral for Outpatient Tobacco Cessation Counseling.
17. Recheck Referral for Outpatient Tobacco Cessation Counseling
a. If Referral for Outpatient Tobacco Cessation Counseling equals 2, 3 or 5 the case will proceed to Measure Category Assignment of D and will be in the Measure Population for sub-measure TOB-3a. Stop processing.
b. If Referral for Outpatient Tobacco Cessation Counseling equals 1, continue processing and proceed to Recheck Tobacco Use Status.
18. Recheck Tobacco Use Status
a. If Tobacco Use Status equals 2, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population for sub-measure TOB-3a. Stop processing.
b. If Tobacco Use Status equals 1, continue processing and proceed to recheck Prescription for Tobacco Cessation Medication.
19. Recheck Prescription for Tobacco Cessation Medication
a. If Prescription for Tobacco Cessation Medication equals 2, the case will proceed to Measure Category Assignment of D and will be in the Measure Population for sub-measure TOB-3a. Stop processing.
b. If Prescription for Tobacco Cessation Medication equals 1, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population for sub-measure TOB-3a. Stop processing.
c. If Prescription for Tobacco Cessation Medication equals 4, continue processing and proceed to recheck Reason for No Tobacco Cessation Medication at Discharge.
20. Recheck Reason for No Tobacco Cessation Medication at Discharge
a. If Reason for No Tobacco Cessation Medication at Discharge equals N, the case will proceed to Measure Category Assignment of D and will be in the Measure Population for sub-measure TOB-3a. Stop processing.
b. If Reason for No Tobacco Cessation Medication at Discharge equals Y, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population for sub-measure TOB-3a. Stop processing.
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