Connecting tobacco users in the primary care setting to comprehensive tobacco treatment: a quality improvement initiative

Purpose The goal of the Stanford Tobacco Treatment Initiative was to improve referrals from primary care clinics to a specialty tobacco addiction treatment clinic. Methods Lean A3 problem solving was used to map current state, perform a cause and effect analysis, develop key drivers for program referrals, and ideate tests of change. We discarded ideas that put any additional burden on on-the-ground providers, favouring automated and sustainable processes. After prioritizing for feasibility and impact, plan-do-study-act (PDSA) cycles were performed on the following interventions: education and outreach, referral champions, and automated referrals. Results Following implementation, referrals to the specialty tobacco treatment clinic increased by 600% and had no impact on clinic provider workflow. Conclusion The new process spread through all of Stanford Primary Care clinics, has sustained over time, and could serve as a model for other institutions seeking to enhance capacity for tobacco treatment in their health care system using process improvement methodology.