Community clinic partner achieved marked improvement in system-based tobacco cessation
March 17, 2025
Tobacco use is the leading cause of preventable mortality. WellSpace Health (WH), a community health system in the Sacramento area, launched a quality improvement project (QIP) to advance “system-based” tobacco cessation.
The project, a collaboration with the UC Davis Center for Healthcare Policy and Research (CHPR), showed substantively improved quality metrics when implemented in an initial WH clinic. Based on this success, the approach was expanded to 14 other clinics in the WH network.
The project results were reported in a case study published this month in Population Health, Equity and Outcomes.
The case study, authored by WH leaders and CHPR researchers, explained the strategies that were linked to significant improvement in the effectiveness of tobacco cessation across WH clinic sites. These sites included underserved communities in Sacramento, Placer and Amador counties in California.
“The prevalence of tobacco use is higher among men, certain racial and ethnic groups, individuals in rural areas, and communities with low income,” said case-study coauthor Neal Kohatsu, a population health researcher at CHPR. “So, it makes sense to focus tobacco cessation efforts on community clinics that serve these populations.”
System-based tobacco cessation
System-based tobacco cessation is the application of evidence-based methods across a clinic’s workflow through a population health lens.
“We worked with WH to support best practices and to provide recommendations for process improvements that would help patients who use tobacco to quit,” said Desiree Backman, a coauthor of the case study and chief of the Prevention Policy and Practice Group at CHPR. “We are delighted that our partnership has advanced health and well-being for the patients and communities served by WH.”
Before this effort commenced, the researchers found numerous roadblocks to tobacco cessation treatment. These roadblocks included not enough system-based training for physicians and staff, limited time for physicians to spend with patients, and lack of practice and treatment support for physicians. Such issues can be fixed with ongoing, in-depth training to reinforce best practices and optimize workflow for better treatment, Backman and Kohatsu said.
Strategies to improve tobacco cessation treatment
The CHPR research team helped WH develop a quality improvement plan for tobacco cessation treatment. They came up with six strategies:
- Assign a tobacco cessation project coordinator to help implement and manage the plan.
- Optimize electronic health records to document tobacco use and support physicians to help patients quit.
- Refer patients to Kick It California, a tobacco quitline that has been shown to increase the likelihood of its users to quit.
- Follow-up with patients to make sure they have the information and support needed to quit.
- Train and support physicians so they know how to use and apply tobacco cessation best practices with their patients.
- Educate patients through proactive outreach, such as through social media, texting, direct mail, and educational materials.
It was successful. WH documented an increase from about 30% to 93% in the percentage of patients receiving advice to quit tobacco."—Jeffrey Hoch, professor, chief of the Division of Health Policy and Management, and associate director of CHPR.
Helping more patients quit tobacco
The proportion of patients receiving tobacco use screening, advice to quit and referrals for further support all increased once the QIP was implemented.
“It was successful,” said coauthor Jeffrey Hoch, health economist and associate director at CHPR. “WH documented an increase from about 30% to 93% in the percentage of patients receiving advice to quit tobacco."
The researchers also found that the proportion of patients screened for tobacco use increased from 24% to 83%.
The researchers say that widespread adoption of similar plans could lead to substantially more patients quitting tobacco — ultimately, saving lives.
Janine Bera, chief medical officer at WH, and Iqra Ahmad, a program coordinator at WH, are co-authors of the case study. Other coauthors include CHPR team members Julia Fleuret and Liane Winter.
The case study was published by Population Health, Equity and Outcomes. QIP is part of the Healthy Living Clinic Initiative led by Backman and Kohatsu. This work was supported by the California Tobacco Prevention Program, California Department of Public Health.
