B26-24 Up in Smoke: A Tobacco Cessation Quality Improvement Project in a Resident Continuity Clinic

Abstract Rationale Tobacco use is the leading preventable cause of morbidity and mortality worldwide. According to the WHO, tobacco use accounts for over 7 million deaths worldwide annually, which includes 1. 6 million deaths due to second-hand smoke exposure. Tobacco use is also responsible for more than 10% of cardiovascular deaths globally and upwards of 33% of cardiovascular deaths in the United States. The American Lung Association reports that smoking expenses near 300 billion annually in the United States and cessation efforts could see a 26% return on investment. Notably, tobacco use tends to be more prevalent in low-to-middle socioeconomic status populations leading to more smoking-related illnesses and deaths in these groups. Methods A quality improvement team consisting of 6 residents and 1 faculty advisor within a community-based hospital internal medicine residency program was assembled. After a root cause analysis of current state, a Plan-Do-Study-Act (PDSA) cycle established a tobacco cessation clinic for dedicated appointment times to discuss opportunities and resources for tobacco cessation. Appointments were held once a month with the attending physician and focused on motivational interviewing as well as pharmacotherapy options available. The outcome measure utilized was overall percentage of clinic patients who identified as current smokers via the electronic medical record charting system. Results At the onset of the quality improvement project, 20. 8% of the clinic patient population actively used tobacco. Monthly analysis of the percentage of patients using tobacco were calculated via the medical record system and showed an overall reduction to 17. 6% at the end of the 6 month intervention (Graph 1). A total of 27 appointments were scheduled during this time, with 9 of the total appointments completed. Pharmacotherapy was prescribed for 8 of the completed appointments. Conclusions The USPSTF has published grade A recommendations to discuss tobacco cessation with patients as this can significantly reduce the risk of major cardiovascular risks. The establishment of a specialized tobacco cessation clinic may provide additional resources for patients and alleviate time constraints for primary care providers in the outpatient center to further discuss tobacco cessation. Continued interventions should be considered to address healthcare disparities for patients as this may be a barrier for tobacco cessation and healthcare access. Future PDSA cycles to increase availability by incorporating resident physicians are currently being planned, and additional motivational interviewing education is being incorporated into didactic sessions to enhance access and reduce barriers to access. This abstract is funded by: None