Problem/Objective: Despite advances in primary care and the development and promulgation of evidence-based clinical guidelines, implementation and outcomes evaluation are generally lacking. Documentation and interventions to address tobacco use, motivation to quit, and exposure to second-hand smoke can be improved in primary care practices, benefiting many more patients. The barriers to implementing clinical guidelines include lack of practical systems and provider knowledge and skills, and insufficient time and reimbursement.

Methods: New West Physicians, a primary care group practice serving over 250,000 patients at 14 medical offices in metropolitan Denver, is using a combined approach to implement clinical guidelines and create a practical tobacco cessation model. Providers and staff are engaged in surveys and focus group processes, academic detailing for clinicians and staff, electronic medical record system supports, specialized training of hospitalists , and reporting of comparative provider performance. Practice pattern audits and discharged hospital patient surveys are conducted.

Results: Over 50% of clinicians and staff participated in the program planning surveys. Improvements identified and implemented include involvement of clinic staff in implementation of the 5A's, and use of a new vital signs flow sheet in routine daily practice. Detailed qualitative and quantitative findings, tools, system changes, and evaluation results from both the planning and implementation grants will be provided at the conference.

Conclusions: A combined approach to primary care systems change to implement tobacco cessation guidelines can be instituted and evaluated in primary care practices.