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Health System Change Partnerships

These partnerships will help build the capacity of Indiana health systems to impact tobacco use, specifically supporting the integration of tobacco dependence treatment. This opportunity allows for organizations to implement systems change initiatives - sustainable, integrated solutions at the organizational level that support clinicians and health systems to address tobacco use consistently and effectively - and provide technical assistance/services targeting the following focus areas:

  1. Implementing Best Practices for Tobacco Dependence Treatment - Care Coordination
  2. Quality Improvement
  3. Utilization of Electronic Health Record (EHR) System.

According to the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update, systems change leads to improvements or modifications in the way health care systems operate to enhance or improve clinician interventions and to integrate tobacco into health care delivery using various strategies. Services may include:

  • Developing processes to ensure that tobacco dependence treatment, and its documentation, is fully integrated into care and sustained over time
  • Implementing quality improvement processes to enable integration of tobacco dependence treatment best practices into routine care
  • Demonstrating meaningful use of the EHR system.

Opportunity exists within the healthcare sector to explore and implement these strategies. These partnerships are expected to lay the foundation for future systems change efforts and build support and knowledge focused on systems change and quality improvement in Indiana. TPC’s vision is to replicate and share lessons learned to continue informing our work and build capacity within health systems to consistently offer best practices in treating tobacco use and dependence.

Health Systems Change Partners:

Cancer Support Community
Cancer Support Community (CSC), a nonprofit organization funded to recruit and provide technical assistance to cancer centers. CSC’s mission is to reduce Indiana’s cancer burden through the coordinated collective action of its members and the sharing of resources, knowledge, and passion to promote prevention and early detection and to support effective treatment and survivorship. CSC, in partnership with the Indiana Cancer Consortium (ICC), recruited cancer pavilions at Good Samaritan and Kings Daughter Health as pilot locations. Both cancer pavilions will create customized implementation plans to address and actively promote tobacco cessation efforts and implement the Clinical Practice Guidelines for Treating Tobacco Use and Dependence.

Community Health Network
Community Health Network is a not-for-profit health system made up of over 200 sites of care and affiliates located across central Indiana. Community Health Network includes a wide range of services including physician care, specialty, and acute care hospitals, surgery centers, and home care services among others. The primary administrative site for the grant is the Community Cancer Center North, located on Indianapolis’ north side; however, grant activities are being piloted in their Anderson, Indiana location. This grant is dedicated to standardizing evidence-based tobacco use and dependence treatment throughout Community Health Network (CHNw). The overall function is to standardize care to include strategic development to foster widespread adoption for evidence-based tobacco treatment, provider education, employee-focused cessation strategies, and standardize workflow in the electronic medical record (EHR) to enhance care and provide analytical feedback and outcome management.

Indiana Hospital Association (IHA)
IHA is a member organization that serves Indiana hospitals through the provision of representation and support. IHA engages in advocacy efforts, builds a network of businesses and healthcare organizations, analyzes and distributes health-related data, and provides a platform for hospitals to share ideas and information. IHA is a funded TPC partner and leads five health systems in their health systems to change efforts: Columbus Regional Hospital, Greene County General Hospital, Marion General Hospital, Baptist Health-Floyd County, and Pulaski Memorial Hospital.

  • Columbus Regional Hospital is a 225-bed, not-for-profit hospital that provides emergency and surgical services as well as comprehensive care in various specialty areas. Columbus Regional Hospital has implemented their system change efforts in their Labor and DeliveryDepartment and is targeting women coming in for their 36-week preparation visit through their 6-week postpartum visit.
  • Greene County General Hospital Greene County General Hospital is a critical access hospital operating in Linton, Indiana, and has 25 inpatient beds. The hospital offers a variety of services including inpatient care, emergency department services, intensive critical care, and surgery, among others. Greene County General Hospital will provide tobacco treatment specialist services within the inpatient Respiratory Therapy and plan to expand to the Chronic Disease Care Navigator face-to-face services.
  • Marion General Hospital is a not-for-profit, acute care hospital and health care organization located in Marion, Indiana, and has 99 inpatient beds. Marion General provides emergency and urgent care, critical care, surgery, and obstetric and newborn care, along with numerous other medical services. Currently, Marion General Hospital is focusing their system change efforts on patients in their inpatient critical care department, providing tobacco treatment specialist services and NRT prescribed with the goal to expand efforts to the Med/Surg and Telemetry units.
  • Baptist Health – Floyd County is a 236-bed, acute care regional healthcare provider with one of southern Indiana’s most advanced comprehensive cardiac surgery programs. Part of Louisville, Kentucky-based Baptist Health, the hospital offers 34 points of care in a full continuum from inpatient care to rehab services to home care. Services include cardiac surgery, stroke care, bariatric surgery, thoracic services, cancer care, diabetic treatment, weight management services, orthopedics, spine care, wound care, pain management, sleep care, and a full range of women’s services including obstetrics. Baptist Health - Floyd County will implement their tobacco system change project in their inpatient Medical-Surgical Unit.
  • Pulaski Memorial Hospital is a 25-bed critical access hospital that provides services lines to many areas including pain management and physical, pulmonary, cardiac, and lymphedema therapies. Pulaski Memorial offers outpatient services including oncology and owns a medical-surgical provider group. Pulaski Memorial Hospital will be implementing their tobacco change efforts in their inpatient and outpatient OBGYN departments.

Indiana Chapter of the American Academy of Pediatrics (INAAP)The Indiana Chapter of the American Academy of Pediatrics (“INAAP”) is a statewide 501(c)(3) nonprofit organization focusing on issues related to health and well-being of all Hoosier children. With over 900 pediatrician and nurse practitioner members throughout the state, INAAP strives to be the go-to resource for questions related to children’s health, as well as for issues related to the practice of pediatrics. The focus of the TPC grant is to build capacity within pediatric offices to impact tobacco use, specifically supporting the integration of tobacco dependence treatment and reduction of secondhand smoke exposure. The implementation of the "Clinical Effort Against Secondhand Smoke Exposure" (CEASE) program will support pediatric offices throughout Indiana. Services will include but are not limited to capacity building, training, technical assistance, data collection, and evaluation. CEASE supports existing child healthcare systems to routinely assess and treat parental tobacco use at every clinical encounter through screening for tobacco use and exposure. Doing so through proactive referrals to the free state Quitline and Smokefreetxt, pharmacologic management of tobacco dependence (NRT patch and gum), and follow-up with parents regarding their tobacco cessation attempts. The CEASE program is currently operational in ten pediatric offices across the state.

Indiana Rural Health Association (IRHA)
The mission of the IRHA is to enhance the health and well-being of rural populations in Indiana through leadership, education, advocacy, and collaboration. IRHA has an excellent rapport and collaborative working relationships with Indiana’s critical access hospitals, 19 rural hospitals, and 79 rural health clinics. Through the TPC funding opportunity, IRHA is guiding three hospitals in their tobacco-focused health systems change efforts: Putnam County Hospital, Franciscan Health-Rensselear, and Decatur County Memorial Hospital.

  • Putnam County Hospital: Putnam County Hospital is a 25-bed, critical access hospital located in Greencastle, Indiana. Putnam County Hospital operates a 24-hour emergency department, intensive care unit, and an acute care medical/surgical unit and provides a variety of services in the areas of cardiology, neurology, and nephrology, among others. Putnam County Hospital also owns three physician practice clinics with one located at the hospital, one in Cloverdale, and one in Bainbridge. Putnam County Hospital is planning their cessation activities in their Women’s Health Clinic facilitated by the OB navigator.
  • Franciscan Health-Rensselaer: Franciscan Health-Rensselaer is a 54-bed critical access hospital located in Rensselaer, Indiana. Franciscan Health-Rensselaer offers emergency services through its emergency department as well as other specialty care services as part of its intensive care unit to residents living in rural Jasper County. The primary sites for cessation activities are the Health Screenings Program and the Brook Rural Health Clinic.
  • Decatur County Memorial Hospital: Decatur County Memorial Hospital is a Critical

Access Hospital located in Greensburg, Indiana. Decatur County Memorial Hospital has over 25 beds, 57 physicians, and includes a medical and surgical unit. In addition to inpatient and surgical services, the hospital also operates several primary care clinics in Decatur County, including a women’s care office. The cessation strategies will include remote cessation counseling and medication and increase staff capacity with tobacco treatment specialty training (TTS).

Rethink Tobacco Indiana
Rethink Tobacco has been a TPC grantee since 2008 and is formerly known as Bringing Indiana Along. Rethink is a statewide initiative aimed at creating awareness and health systems change related to treating tobacco use and dependence in behavioral health settings. Its program focus is to reduce the prevalence of tobacco and nicotine use among persons with mental health conditions, substance use disorders, or co-occurring disorders through the following free activities and resources:

  • Technical Assistance – assist behavioral health centers with the integration of evidence-based tobacco treatment service
  • Policy Development – support behavioral health treatment centers with developing and implementing tobacco-free grounds policies
  • Education –provide education to clinical practitioners, i.e. webinars
  • Specialized Training – provide specialized training on topics such as pharmacotherapy and e-cigarettes.
  • Resources

Southwestern Behavioral Health
Southwestern Behavioral Health is a community mental health center located in Evansville Indiana and offers a full range of mental health services including residential and outpatient addiction services for adults, children, and family-oriented mental health care; and community-based programming. Southwest Behavioral Health initially focused their tobacco-related system change efforts in three clinics but as of January 2020 expanded their cessation strategies system-wide into their 14 clinics.

Technical Assistance Partners:

IU Center for Health Policy, (Evaluation Grant)

Faculty and staff from the Center for Health Policy (CHP) will evaluate the Health Systems Change Partnership activities among the selected grantees using a mixed‐methods approach. A qualitative component will include a review of relevant project documents and key informant interviews. A quantitative component will include the use of a tool to track changes in key data elements (as available) to measure changes in system-specific metrics from baseline. Both mid-year and annual reviews and subsequent reports are available to measure strategies throughout the project period. Ongoing evaluation topics include obtaining and sustaining leadership support, accessing process and outcome data necessary for tracking and developing billing processes for the long-term sustainability of cessation practices.

Purdue Healthcare Advisors, (Quality Improvement Grant)

TPC has a continuing partnership with Purdue Healthcare Advisors (PHA). PHA provides technical assistance to the tobacco cessation grantees through lean daily improvement and lean facilitation training as well as offering supportive quality improvement strategies focused on integrating health systems change for treating tobacco dependence.