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Although hospitalization is seldom a desired health care outcome, it can at least offer tobacco users the chance to receive cessation interventions. Unfortunately, this potential is not commonly realized. Studies show that many hospitals do not consistently provide cessation services to their patients. One reason is that previous Joint Commission performance measures, starting in 2004, required U.S. hospitals to report only the proportion of smokers who received tobacco-cessation and then only for those adults admitted for acute myocardial infarction, congestive heart failure, or pneumonia. Thus, the previous set of measures focused on a limited population and did not require that hospitals provide effective cessation interventions, such as counseling or cessation medications approved by the Food and Drug Administration and recommended in the Public Health Service's 2008 Clinical Practice Guideline . In addition, a recent analysis documented that hospitals were able to “game the system,” with scores approaching 100% on the tobacco-treatment measure, prompting the National Quality Forum to abandon tobacco-use intervention as a quality measure. In sum, the previous set of performance measures fell short. Many hospitals reported high compliance rates, but in reality, too many tobacco users left hospitals with too little help.

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Does the new set of performance measures improve on the previous set, and will it deliver on its promise? Our perspective is that, although tactically impressive, the measure set is strategically flawed because its adoption is optional. Accredited hospitals are required to report on only 4 of the 14 available Joint Commission sets of performance measures, with no requirements regarding which must be chosen. (The other 13 measure sets are for acute myocardial infarction, heart failure, pneumonia, surgical care improvement, perinatal care, children's asthma care, hospital outpatient care, venous thromboembolism, stroke, hospital-based inpatient psychiatric services, immunization, the emergency department, and substance abuse.) Our concern is that most hospitals will eschew the tobacco-cessation measure set because it requires greater effort and resources (intensive identification, treatment, and postdischarge follow-up of all tobacco users), than the other measure sets do.

 

The Joint Commission announced that starting Jan


Few factors influence health care standards in the United States today more than the actions of the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations). And few opportunities hold more promise for increasing the rate of tobacco-use cessation than patient contact with the health care system. Health care visits represent teachable moments when a patient's very real fears and concerns about tobacco use can provide a particularly powerful motivation to quit. The Joint Commission's new Tobacco Cessation Performance Measure-Set took effect on January 1, 2012. Will implementation of these measures improve smoking-cessation treatment by capitalizing on the Joint Commission's power to change hospital care practices and the opportunity offered by health care encounters? Or will hospitals neglect this opportunity, citing the pressures of other priorities?


Of course, Joint Commission actions are not the only routes to improved tobacco intervention in the health care setting. For instance, “meaningful use” criteria and incentives, a key component of the 2010 Patient Protection and Affordable Care Act, include tobacco dependence as a core required outcome measure for health care systems. The act also mandates that, by 2014, new insurance plans provide coverage for evidence-based prevention treatments, including those for tobacco cessation. In other areas, the National Quality Forum is considering the adoption of the new Joint Commission tobacco-use standard, and the Centers for Medicare and Medicaid Services have added the treatment of tobacco dependence as a topic for potential regulation in 2013; such regulation could link the documentation of consistent delivery of tobacco-dependence treatment in health care settings to reimbursement. Despite these alternative approaches to enhancing health care, the Joint Commission performance standards remain critically important.


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Although the Joint Commission has not prioritized the performance measure set for tobacco cessation over other sets of quality-assurance measures, we believe that U.S. hospitals face a medical and moral imperative to select it and meet its requirements, given the continuing prevalence of tobacco use, its profound costs in terms of health and happiness, and the ready availability and feasibility of effective treatments. Helping patients quit using tobacco is one of the greatest preventive care efforts in which hospitals can engage, and it is likely that other regulatory bodies will soon require such efforts. To this end, the 2012 Joint Commission Tobacco Cessation Performance Measure-Set represents an ideal opportunity to apply a very meaningful set of effective interventions in the health care setting — if only hospitals will adopt them.