The following are strategies to support the sustainability of tobacco treatment programs (TTPs), organized by Clinical Sustainability Assessment Tool (CSAT) domains and informed by input and case studies from C3I participants:
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Engaged Staff & Leadership
- Secure leadership support for program implementation.
- Engage multidisciplinary teams, including Health Information Technology (HIT) staff and clinic champions.
- Involve TTP leadership and staff in various multidisciplinary meetings (e.g., huddles, rounds, case conferences, tumor boards).
- Use internal marketing and communication to engage at the clinic or health system-level (e.g., staff newsletters, education materials).
- Share high impact articles and monographs on TTPs and the effects of tobacco cessation on cancer outcomes with leadership and staff.
- Report program outcomes to leadership and staff.
- Conduct staff surveys for input on future directions.
Engaged Partners
- Develop strategic external partnerships. For example:
- American Society of Clinical Oncology
- Centers for Disease Control and Prevention
- Commission on Cancer
- National Comprehensive Cancer Network
- National Tobacco Treatment Specialist Programs
- Association for the Treatment of Tobacco Use and Dependence
- Lung cancer and cancer screening programs
- National and state quitlines
- Patient, survivor, and family advisory boards
- Office of Community, Outreach, and Engagement (COE)
- Local community groups
Organizational Readiness
- Conduct a needs assessment to define readiness (e.g., how much funding is needed, how much staff effort is needed).
- Secure leadership commitment for necessary funding and resources.
- Develop a TTP manual to ensure continuity through staff turnover. Include programmatic standards, reporting procedures, key performance indicators.
- Foster partnerships with complementary initiatives (e.g., other cancer prevention programs; Community, Outreach, & Engagement; etc.).
Workflow Integration
- Visit clinics to better understand the current workflow.
- Adopt a team-based model of care to engage clinic staff.
- Automate processes in the electronic health records to screen, refer, and follow up with patients.
Implementation & Training
- Create a library of provider– and patient-facing educational resources.
- Create tailored, asynchronous digital learning modules for staff.
- Provide multiple opportunities for training and retraining.
- Develop standard operating procedures, scripts, and practice tools to deliver evidence-based care.
- Sponsor TTS training for clinical champions and providers.
- Work with the Health Information Technology (HIT) team to develop tip sheets for providers.
- Provide continued education and encouragement of participation through regular newsletters.
Monitoring & Evaluation
- Budget the staffing and resources necessary to monitor and evaluate the TTP.
- Build partnerships with the reporting team.
- Work with Health Information Technology (HIT) personnel to develop and automate EHR-based program metrics reporting on key performance indicators.
- Work with HIT personnel to develop EHR-based tobacco registry.
- Track implementation and maintenance costs.
- Share regular monitoring and evaluation reports with TTP personnel based on the metrics that matter to leaders and clinic champions.
- Document processes for replication.
Outcomes & Effectiveness
- Use metrics and reporting requirements that align with leadership, clinical, research, and health system priorities.
- Measure impacts valued by external partners, including patients, policy makers, and funders.
- Link cessation to clinical outcomes.
