Smoking is the leading cause of preventable death and disability. In 1996 the Agency for Health Care Policy and Research published its "Clinical Guideline for Smoking Cessation". This guideline endorses the four key performance components of tobacco cessation activities for practices: Ask, Advise, Assist and Arrange. However, there is a substantial body of literature suggesting that there are significant barriers for physicians in attempting to undertake these activities. One barrier is the lack of performance data at the physician level. That is, data that allows the physicians to know 'how they are doing' in supplying smoking cessation services to their patients. This proposal attempts to answer the question: does personalized data-feedback (profiling) of tobacco cessation performance to physicians improve their provision of these services? This study has two primary aims: (1) To evaluate the effect of tobacco cessation profiling on provider and practice behavior around tobacco user identification and treatment. (2) To evaluate the effects of the practice interventions on the quitting behavior of smokers. Two secondary aims are: (1) To assess the influence of provider and practice characteristics on practice adherence to smoking cessation guideline recommendations. (2) To assess the influence of health insurance benefits for smoking cessation services on the behavior of smokers. In a randomized controlled trial, three strategies will be compared (i) Mailed 'generic' information on tobacco cessation, (ii) Mailed performance data feedback to providers and practices, and (iii) Educational office visits with performance data feedback to providers and practices. The patient study population will be comprised of smokers enrolled in two managed care plans and Maine Medicaid beneficiaries. Physicians will be recruited from practices having at least 200 study patients (combined population). Performance and practice level outcomes will be assessed from chart audits of study practices and claims data from all three payers. Through baseline and follow-up telephone surveys, the study will assess attempts at quitting, utilization of cessation treatments (counseling and pharmacotherapy), and abstinence from smoking for patients of the study practices receiving one of the three intervention strategies.
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