Continued evaluation of tobacco treatment program (TTP) outcomes and impact is key to sustainability. Regularly monitoring program progress enables teams to identify successes and strategically plan adaptations, report key outcomes to interested parties, and demonstrate the value of the program to potential funders.
Choose assessment measures and reporting processes that can be maintained with minimal effort; automate data collection and extraction in the EHR; and budget the necessary funds to support sustained evaluation. Consider including the following measures to assess sustainability over time.
Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM)
Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework (Glasgow et al., 2018) emphasized in C3I (D’Angelo et al., 2020):
| Maintenance over time of: | |
| Reach | Proportion of patients receiving tobacco treatment |
| Effectiveness | Patients who report abstinence, among all cancer patients receiving treatment. |
| Adoption | Proportion of settings, teams, and providers who screen for tobacco use, offer tobacco dependence treatment, refer to treatment, and provide treatment to patients. |
| Implementation | Proportion of patients screened for tobacco use and proportion of patients referred to treatment. |
Cost Evaluation and Return on Investment (R01)
Economic evaluations have found tobacco treatment programs (TTPs) to be relatively cost-efficient (Salloum et al., 2021) (Pluta et al., 2023). At the same time, the healthcare costs associated with smoking prevalence are staggering (Warren et al., 2019), and the potential return on investment for tobacco treatment is significant (Richard et al., 2012). These financial arguments can help strengthen your case for sustained funding.
- Operation Costs = Staff, personnel, resources associated with staff recruitment and training, and resources for maintaining data on participants. Could include:
- Personnel and effort plus fringe benefits
- Medications covered by the program
- Educational and promotional materials
- Staff training
- Technology services
- Equipment and office space
- Cost-per-participant = Total operation costs divided by the number of patients that engaged in TTP services within a given period
- Cost-per-quit = Total operation costs divided by the number of patients who reported seven-day abstinence from tobacco use over a 6-month time period
Impact on Clinical Outcomes
Linking tobacco treatment with clinical outcomes can demonstrate the broad impact of your program on patient health. Is tobacco treatment associated with decreased lengths of stays, readmissions, emergency care visits, morbidity, and mortality for patients?
Impact on Health Equity
Racial and ethnic minority populations and LGBTQ+ communities face a disproportionate burden of tobacco-related cancers. A population-based approach to tobacco treatment with targeted proactive outreach has potential to reduce health disparities and increase reach equity for these populations (D’Angelo et al., 2021). Measure outcomes across patient subgroups and align community outreach efforts with other initiatives in your health system. Demonstrating the health equity impact of your tobacco treatment program (TTP) can help secure sustained funding. See the Health Equity Module for more resources to help all patients benefit from tobacco treatment.
