Monitor Progress

• Adoption: Proportion of settings, teams, and providers who screen for tobacco use, offer tobacco dependence treatment, refer to treatment, and provide treatment to patients.
• Workflow Steps: Including referral and order cancellation rates.

• • C3I example: See Case Study F for an example of how monitoring EHR order cancellation rates led to an effective adaptation that enhanced the reach of tobacco treatment.
• Tobacco Use Screening: Proportion of patients screened for tobacco use among all patients at the cancer center.
• Tobacco Treatment Referral: Proportion of patients referred to tobacco treatment.
• Reach: Proportion of patients receiving tobacco treatment. (See sample monthly and cumulative reports).
• Effectiveness: Patients who report abstinence, among all cancer patients receiving treatment. (See Piper et al., 2020 for guidance on defining and measuring abstinence).
• Maintenance: Extent to which program components are sustained. The Clinical Sustainability Assessment Tool (CSAT) can be used to evaluate the capacity for sustainability of clinical practices. See the Sustainability Module for additional sustainment measures.
• Equity: Reach and effectiveness by patient demographics, including gender, race, ethnicity, and age.

When working with your HIT team to build EHR supports for the workflow, ensure the measures you plan to monitor can be extracted for reporting. Start this process early!

See this sample dashboard report and the C3I Epic EHR Build Guide (pgs. 56-69) for additional examples.

Reporting implementation and program outcomes can require significant time and effort. Develop an automated or low-labor process for sharing key results.

Can your business intelligence team support this reporting at the necessary frequency and capacity? If not, another team member will need to lead the reporting process.

Monthly, quarterly, biannually at cancer program review meetings? Determine a monitoring frequency that aligns with opportunities to report to interested parties and can be supported by your reporting team or other staff.

C3I example: See Case Study G  for an example of how joining monthly team meetings at participating sites can enhance implementation.

• Report up to leaders and back to implementation teams to share successes and opportunities for improvement.
• Formal audit and feedback to clinic teams can enhance implementation. Consider a theory-based Interactive and Participatory Audit and Feedback (IPAF) approach to collaboratively realign team behaviors with best practices and quality improvement goals (Ramly et al., 2021).
• Sharing former patient success stories and testimonials with new patients may enhance confidence in the program.

In addition to patient demographics, consider assessing acculturation-related variables (Castro et al., 2018), feelings of discrimination and chronic stress (Cancer Center Cessation Initiative Diversity, Equity, and Inclusion Working Group Members, 2021), and social determinants of health (Ashing et al., 2022) and their relationship to tobacco use, tobacco treatment, and cessation.

Keep the implementation team engaged in monitoring program outcomes. Repeat Plan-Do-Study-Act (PDSA) cycles to test and refine adaptations.

• C3I example: See Case Study L for a C3I program that gathered clinic team feedback to adapt screening and referral tools and enhance program implementation.

If making substantial changes to the intervention, consider going back to the beginning and piloting the new workflow.

• C3I example: One C3I center prepared to launch a point-of-care tobacco treatment workflow; however, with the loss of two clinic champions and shifting priorities during the COVID-19 pandemic, this approach was no longer feasible. The team pivoted to a specialty care model with a tobacco treatment specialist (TTS) providing telehealth counseling.