Characteristics of Chronic Disease Self-Management Programs (CDSMP) that include tobacco – 7/3/12

Q: The Chronic Disease Director in North Carolina wants to know what states have strong Chronic Disease Self-Management Programs (CDSMP) that include tobacco in the program. We understand that there are possibly a handful of states that have strong CDSMPs that are not built on the “Stanford Model” which does not include tobacco. For those states that have a CDSMP that does include tobacco, please provide the following program characteristics:

• Who administers the program?
• How are individuals trained to run the program?
• How was the program developed?
• How are people recruited?
• What is the reach of the program?
• What criteria does the state have for maintaining standards about program implementation?
• What components are included in the program for tobacco? (i.e., tobacco cessation, prevention of initiation, elimination of SHS)

A:

1. Oregon: Although Oregon's CDSMP program doesn't specifically include tobacco or cessation-related content due to Stanford's licensing restrictions and the need to maintain program fidelity for outcomes, Oregon has integrated referrals to CDSMP/Tomando Control de Su Salud into our Quit Line process. The attached slide deck provides an overview of how it works, the process we went through to put the referrals in place, outcomes and next steps. Feel free to contact the Oregon Tobacco Program staff if there are questions.
    
2. Vermont: Vermont has a strong commitment to self-management as part of our healthcare reform initiative, The Blueprint for Health. Information about the Blueprint can be found here.
    
   The Vermont Tobacco Control Program (TCP) has been offering group and individual cessation counseling since 2002. VT offers a comprehensive array of cessation services, branded the Vermont Quit Network. Since 2008, the TCP has had dwindling budgets. In the last fiscal year, we made plans to cut this program entirely. At that point, the Blueprint stepped in with financial support and we have developed a partnership to allow for the program to continue.
    
   Who administers the program?
   The program is a shared resource. The Blueprint reimburses communities through its issuing of self-management contracts (which include Stanford model programs). Also, as part of healthcare reform, the Blueprint administers "community health teams". Our private insurance companies, plus through waivers with Medicaid and Medicare, combine to pay for 5 FTEs that are designed to do panel management. There will be a community health team for every 20,000 patients that belong to a Patient Centered Medical Home practice. The long range (sustainable) goal for tobacco cessation delivered in the community is to have one of the 5 FTEs be trained as a tobacco treatment specialist.
    
   The Vermont Department of Health (TCP) administers the nicotine replacement therapy program that these counselors can provide to clients who enroll. We also have a budget each year where training for counselors is provided, and we conduct a 6 month evaluation of the program using a follow up survey that mirrors NAQC's MDS. This program remains part of our brand and our marketing efforts include the face to face programming.
    
   How are individuals trained to run the program?
   We offer the American Cancer Society's Fresh Start cessation classes. To offer classes we require that an individual complete UMass Medical School's basic skills on line training, the ACS program, as administered on their website, plus an additional 6 hour course of our own design.
    
   Additionally, we also offer the opportunity for folks to become tobacco treatment specialists. These folks take the 4 day course provided through UMass. This is an opportunity that we reimburse folks to take. It is also a requirement that each of the 13 areas have one active tobacco treatment specialist.
    
   How was the program developed?
   The program has been developed over the course of the 10 years that it has been running. The requirements above were developed in conjunction with the Blueprint. This redesign of our requirement wasn't too far removed from what we have been requiring for the last 10 years. We have been using UMass for training over that time period. We will also accept tobacco treatment specialists that have completed ATTUD certified training at either Mayo or University of New Jersey's Medical and Dental school.
    
   Moving the personnel costs to the Blueprint for Health has (hopefully) created a sustainable program. The program got cost prohibitive because of the personnel costs. Several years ago, the TCP switched to a grant relationship where sites are paid for completed classes, and received many complaints that this arrangement didn't cover costs for the sites.
    
   Now that Blueprint includes tobacco cessation in with other self-management (and many of the same people can offer both) it seems to be a little better business model, but there are still some concerns about covering costs.
    
   How are people recruited?
   The TCP also has a sizable media budget that it uses (in part) to promote our cessation programming. The face to face programming is included in that promotion. Our quitline also tells smokers that the face to face option is available.
    
   Where we really feel that things will pay dividends over time is the relationship that smoking cessation has with the community health teams. As these teams work with practices to have them become and maintain National Committee for Quality Assurance (NCQA) certification, the hope is that our medical practices will get better at referring smokers to smoking cessation programs.
    
   What is the reach of the program?
   Currently the Vermont Quit Network programs combined reach 6% of our smoking population (88,000 smokers). Last fiscal year the face to face program saw 1,250 smokers or about 1.4% of our smoking population. Because of some turn over, this was a down year (numbers wise) for the program. In its history, the face to face programming has seen as many as 2.0% of the smoking population.
    
   What criteria does the state have for maintaining standards about program implementation?
   In additional to the training criteria, we require that sites have at least 5 people in a group to start. Sites get a reimbursement for each class that they offer, a separate rate for each person that starts the series of classes, and a separate rate for each person that finishes a series of classes. As mentioned we also conduct an evaluation of the program at 6 months post quit, mirroring the standards that are set forth by NAQC.
    
   What components are included in the program for tobacco? (i.e., tobacco cessation, prevention of initiation, elimination of SHS)
   This is only a tobacco cessation program. The TCP does other programming for prevention and secondhand smoke, but those are administered through different partners.

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