Oklahoma Partners Collaborate with Tribes on Tobacco Cessation

May 21, 2018 | Talyah Sands, Ramya Dronamraju

Tobacco use is the leading cause of preventable death in the United States, and also makes the top of the list in Oklahoma, where the prevalence of tobacco use among the American Indian population remains higher than any other racial group. To address this disparity, partners in Oklahoma have collaborated with tribal nations on health systems change to enhance tobacco cessation.

The Oklahoma State Department of Health (OSDH) supports these efforts through the Oklahoma Health Systems Initiative (HSI), which coordinates and enhances statewide tobacco cessation efforts. Through this initiative, OSDH supports the Oklahoma Hospital Association (OHA) in working with tribal health systems to enhance tobacco cessation rates within their patient population. ASTHO spoke with Christin Kirchenbauer, cessation systems coordinator at the Oklahoma State Department of Health, to learn more about state public health collaborations with health systems in tribal nations.

What is the Oklahoma HSI and who is involved?

The HSI serves as a resource for coalitions, community organizations, tribal nations, and healthcare providers to provide technical assistance for the implementation of best practices for treating nicotine dependence within healthcare settings utilizing a systems-based approach. Partners do this through education, advocacy, and system-level change, with a focus on promoting the Oklahoma Tobacco Helpline (OTH).

Three key organizations of the HSI collaborative are funded by the Oklahoma Tobacco Settlement Endowment Trust (TSET) to play a crucial role in the cessation initiatives:

• Oklahoma Hospital Association (OHA) which works with hospital administrative and clinical leadership to develop a comprehensive sustainable tobacco-free culture.
• Oklahoma Health Care Authority (OHCA): As the state Medicaid agency, OHCA works with Medicaid providers statewide to incorporate evidence-based tobacco dependence treatment strategies.
• Oklahoma Department of Mental Health Substance Abuse Services (ODMHSAS): The ODMHSAS provides technical assistance and training to contracted and state-funded mental health and substance abuse centers on the clinical best practices.

What does integration of tobacco cessation through the HSI look like?

The OHA initiative, Hospitals Helpline Patients Quit (HHPQ), integrates clinical practice guidelines for tobacco treatment (using the 5As framework) into its member organizations. The core systems change focus of the HHPQ program includes:

• Policies and procedures to support a tobacco-free environment.
• Best practices to support employee tobacco cessation.
• Clinical best practices to support patient tobacco cessation and referral for follow up support.
• Data collection and evaluation to guide benchmarking and ongoing support.

Since 2010, HHPQ has worked with over 50-member hospitals and their affiliated clinics, resulting in over 24,000 referrals for follow up tobacco cessation counseling from the Oklahoma Tobacco Helpline.

The OHA also collaborates with other partners and hospital organizations to incorporate direct referrals to the OTH via electronic medical records.

Tell us about tribal engagement in the HSI and how partners are supporting tribal health systems.

A tribal cessation workgroup, facilitated by the OSDH, was created as a collaboration assembling key stakeholders and content experts around commercial tobacco cessation and health systems designs. The workgroup’s primary focus is to ensure all Oklahoma American Indians are provided essential coordinated tobacco use and prevention services by reducing barriers and improving access to services.

Can you share a success story of the HSI in working with tribal nations to initiate systems change around tobacco cessation?

In 2014, the OHA began working with the Chickasaw Nation Medical Center (CNMC) through its HHPQ initiative to enhance tobacco cessation rates with their patient population. This collaborative effort has resulted in:

• Full integration of tobacco treatment best practices and workflows into the CNMC’s EMR.
• Development of the first bi-directional e-referral to the OTH, launched in November 2015; at that time, the CNMC was amongst only a handful of hospitals in the nation advancing this best practice treatment and technology.
• Development of provisions to discharge patients who are ready to quit with FDA-approved tobacco cessation medications.
• Implementation in the CNMC’s main hospital and over 15 different outpatient clinics
• Almost 3,000 referrals to the OTH from November 2015 to December 2017.

What is the Oklahoma State Department of Health doing to bolster and sustain the HSI efforts?

The OSDH Tribal Cessation Workgroup and the HSI are exploring health system changes at a higher level. This would minimize resources and time working with individual organizations and instead approach the system at a higher level and would be helpful when working with tribal health systems utilizing similar EMRs.

The partners involved in these efforts recognize the importance of finding a champion when working with a health system for the continued success and utilization of the tobacco cessation efforts. It has also been helpful to incorporate other tribal organizations such as the Southern Plains Tribal Health Board for feedback and partnership.

What cultural considerations are important to engaging with tribal partners in this work?

The Tribal Cessation Workgroup and the OSDH rely on partnerships and relationships with experts and individuals that work directly with the tribal nations. It is important to work with the tribal nation and rely on their expertise and knowledge of what will work for their community and health systems. The OSDH utilizes existing partnerships with the OSDH Office of Tribal Liaison as well as grantees to help shape the work that is accomplished in Oklahoma. 

What recommendations do you have for other state health departments who want to collaborate with tribes to create systems change around tobacco cessation?

• Build upon existing tribal relationships to cultivate opportunities to create tobacco treatment systems change.
• Generate top leadership support to create sustainable tobacco treatment systems change within a healthcare system.
• Take a flexible approach to integration of tobacco treatment systems; each healthcare system, particularly tribal healthcare systems, has unique strengths, limitations, and considerations to create sustainable tobacco treatment systems change.
• Embed tobacco treatment operations into the EMRs of healthcare systems with integrated hospitals and clinics; this conforms to modern practice standards, creating an opportunity for enhanced sustainability and impact.