Methods: In late 2004, the New York State Department of Health created 19 tobacco control centers around the state, charged with providing training and technical assistance to individual providers and health care systems. In January, 2005, the Bronx tobacco control center began to offer provider education, assistance with systems change, audit/feedback, a website tailored for local providers, regular meetings and communications, and a competition among clinical sites to increase the visibility and use of the fax referral program.

Results: Prior to program onset, no Bronx providers made fax referrals to the Quitline. After a three-month run-in period, a steady monthly increase was noted; since April, 2006, an average of 80 monthly referrals have been made by Bronx providers. In 2006, 906 fax referrals were made by Bronx providers to the Quitline, representing 0.5% of all Bronx smokers. This usage exceeds that of any other county in the state with a population greater than 500,000. Many sites have introduced systems changes to integrate fax referrals into routine clinical and administrative workflow.

Conclusions: A multicomponent program consisting of training, systems change, chart audit and feedback, friendly competition, and frequent communication can lead to a sustained increase in the use of Quitline referral services by disparate groups of health care providers.