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Dissociation Between Hospital Performance of the Smoking Cessation Counseling Quality Metric and Cessation Outcomes After Myocardial Infarction
Gordon R. Reeves, MD, MPT;
Tracy Y. Wang, MD, MS;
Kimberly J. Reid, MS;
Karen P. Alexander, MD;
Carole Decker, RN, PhD;
Homaa Ahmad, MD;
John A. Spertus, MD, MPH;
Eric D. Peterson, MD, MPH
Arch Intern Med. 2008;168(19):2111-2117.
Background Recognizing the importance of smoking cessation after acute myocardial infarction (AMI), the Centers for Medicare & Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations currently uses documentation of smoking cessation counseling (SCC) as a metric of hospitals' quality of AMI care. Yet, the association between hospitals' performance of this quality measure and subsequent tobacco cessation rates has not been established.
Methods We analyzed 889 consecutive smokers treated for AMI at 19 hospitals in PREMIER (Prospective Registry Evaluating Myocardial Infarction: Events and Recovery) between January 1, 2003, and June 28, 2004. Patients were followed up for 1 year after hospitalization. Multivariate regression modeling was performed to determine the association between hospital-level documented SCC rates and tobacco cessation rates after discharge.
Results On a hospital level, the median medical record–documented SCC rate was 72.0% (interquartile range, 59.6%-90.1%). At 1 year, the median smoking cessation rate was 55.6% (interquartile range, 37.5%-61.9%). Although patients with documented SCC were more likely to recall receiving SCC at 1 month (86.1% vs 70.8%, P < .001), their rate of quitting at 1 year was lower than that of patients without documented SCC (50.1% vs 60.7%, P = .02; relative risk, 0.76; 95% confidence interval, 0.61-0.94). At the hospital level, there was no correlation between SCC documentation and successful quitting at 6 months (r = –0.19, P = .11) or 1 year (r = –0.13, P = .45).
Conclusions The performance metric for SCC, as it is currently structured, does not correlate with actual smoking cessation at 6 months or 1 year. Revision of this performance measure should be considered to more effectively reflect the goal of promoting smoking cessation.
Author Affiliations: Departments of Internal Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina (Drs Reeves, Wang, Alexander, and Peterson); and Mid-America Heart Institute of Saint Luke's Hospital and University of Missouri–Kansas City (Ms Reid and Drs Decker, Ahmad, and Spertus).
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