Interventions to implement a clinic-based smoking cessation guideline within a staff model HMO

Smoking cessation guideline development has become widespread, outpacing gu ideline implementation efforts. To address this problem, HealthPartners und ertook a randomized trial of strategies to enhance compliance of a smoking cessation guideline. The intervention aimed at clinic leadership resulted i n significantly more compliance, as measured by physicians coding "tobacco use" on a billing form. The intervention aimed at all clinic physicians had no significant effect. The study suggests that smoking cessation guideline efforts should focus on clinic leadership and system changes rather than o n all staff physicians.