romoting Smoking Cessation in the Healthcare nvironment

s b c M N t 2 e e c c a i decade ago there was great optimism for harnessing the healthcare system to increase the use of evidence-based tobacco-dependence reatment and, ultimately, to achieve national goals for eductions in the prevalence of tobacco use. Two atalysts for addressing tobacco in health care at that ime were the newly released Agency for Health Care olicy and Research (AHCPR) (now the Agency for ealthcare Research and Quality [AHRQ]) Clinical ractice Guideline, which documented that brief primary are counseling and pharmacotherapy could double opulation quit rates,1 and the inclusion of primary are provider advice to quit as a National Committee or Quality Assurance’s (NCQA) Health Plan Employer ata Information System (HEDIS) measure.2 The clinical practice guideline was visionary in its ecognition of the importance of healthcare system hanges to institutionalize tobacco-dependence treatent rather than relying solely on clinicians to take ction. Recommended health systems strategies inluded implementing tobacco user identification sysems; provider education, resources, and feedback; edicated staff to foster the delivery of treatment; ospital policies to support inpatient cessation services; overage for evidence-based behavioral and pharmacoogic treatments in all insurance packages; and accountbilities and reimbursement for clinicians to deliver essation treatments as a routine part of clinical care.1 With its broad reach into the population, more entralized systems of care, and unique incentives for revention, many believed that managed care offered n unprecedented opportunity to make tobacco-use creening and intervention the standard of care for uality healthcare delivery.3 Projections were that by 005 the majority of commercially insured U.S. citizens ould be enrolled in managed care.4 Thus, getting anaged care organizations to coalesce on provider