Linking low SES and racial/ethnic minority populations to evidence-based cessation treatment through health system changes

With the adoption of electronic health records, the New York State Smokers’ Quitline (NYSSQL) paper-based fax referral system is becoming obsolete. In response to this practice transformation the NYSSQL launched Opt-to-Quit (OTQ). OTQ is a policy-driven, system-wide solution for facilitating smoker referrals through a streamlined electronic data exchange between the NYSSQL and the healthcare organization. Due to barriers in implementation few healthcare organizations have adopted the OTQ referral model; specifically none in New York City (NYC). The goal of the proposed project is to implement OTQ in two Federally Qualified Health Centers (FQHCs) that serve low socioeconomic status (SES) and racial/ethnic minority populations in NYC to ensure disparate populations are receiving evidence-based smoking cessation treatment. A multi-level evaluation, using RE-AIM  (reach, effectiveness, adoption, implementation and maintenance) as a framework, will be conducted to determine the extent to which the proposed project addresses the broad gap that exist between the number of low SES and racial/ethnic minorities served by FQHCs and the rate of smokers connected to NYSSQL. The evaluation emphasizes both process and outcome measures to ensure that we are able to assess both if the intervention worked and why it worked (i.e. What were the processes needed to implement OTQ). The primary goal of this proposal is to develop a highly replicable step-by-step protocol for implementing OTQ that addresses current barriers to adoption and results in higher rates of quitline referrals, increased engagement in treatment and improved cessation rates among low SES and racial/ethnic minority smokers.