Measure Information Form

Measure Set: Screening and Treating Tobacco and Alcohol Use(TAM)

Set Measure ID: TAM-01

Performance Measure Name: Tobacco Use Screening

Description: Hospitalized patients who are screened during the hospital stay for tobacco use (cigarettes, smokeless tobacco, pipe and cigars) within the past 30 days.

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 user’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 brief clinician advice, individual, group, or telephone counseling, and use of 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.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: The number of patients who were screened for tobacco use status

Included Populations:

Patients who declined screening

Excluded Populations: None

Data Elements:

Tobacco Use Status

Denominator Statement: The number of hospitalized inpatients 18 years of age and older

Included Populations: Not applicable

Excluded Populations:

Patients less than 18 years of age

Patients who are cognitively impaired

Data Elements:

Admission Date

Birthdate

Cognitive Impairment

Discharge Date

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and, if applicable, medical record documents. 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/serice. 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.

Measure Analysis Suggestions: Hospitals may wish to analyze data to show the rate of those who were actually screened for tobacco use status, subtracting those that refused the screen.

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. 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:

Attach file

TAM-1.vsd: TAM-1.vsd

Related Topics

Measure Information Form TAM-01

Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)