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Defining Systems

Broadly defined, “health systems change” includes sustainable, integrated solutions at the health care organization level, as well as the changes in health care policy and financing to promote and support universal, evidence-based interventions with all tobacco users.

At the hospital, clinic, or practice level, the “system” includes organizational goals and policies; administrative, information technology, and quality improvement supports; and clinical education and training. At the state policy level, “systems change” includes improvements in insurance benefits and provider reimbursement for cessation interventions. Also included are a range of clinician education and marketing strategies to promote clinician behavior change and increased use of telephone-based quitlines by providers and their patients.

section2 integrated_system

This diagram depicts three evidenced-based, population wide-strategies—comprehensive, barrier-free cessation benefits, tobacco interventions in healthcare facilities, and quitline integration into healthcare. Tobacco control programs and their partners can leverage new policies and performance standards at the national level to support policy and systems improvement at the state level. At the same time, dramatic results published recently on the Massachusetts Medicaid Cessation Benefit Program (A Longitudinal Study of Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Hospitalizations for Cardiovascular Disease and Medicaid Coverage for Tobacco Dependence Treatments in Massachusets and Associated Decreases in Smoking Prevalence) and new research from the Collaborative on the impact of consistent tobacco interventions in healthcare can help make a powerful case for both barrier-free benefits and adoption of Public Health Service Guideline systems-level recommendations.


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