POLICY TO SUPPORT TOBACCO TREATMENT IN HEALTH CARE

48个州最近的烟草问题解决方案将对州公共卫生部和其他机构提出挑战，要求它们制定和实施旨在预防、控制和治疗烟草使用的公共和组织政策。 全国公认的马萨诸塞州烟草控制计划（MTCP）是全国最大的单一目的公共卫生倡议，包括主要通过社区卫生机构（CHS）内的烟草治疗专家（TTS）提供的烟草治疗服务。 这项研究的目的是评估目前的马萨诸塞州政策，旨在使有效的烟草治疗服务提供给广泛的成年烟草使用者，特别是那些最大的风险（例如，服务不足、低收入、以行业为目标的少数群体），并为未来的政策提供信息。拟议的研究分为两个阶段。 第一阶段是一个描述性的案例研究的纵向发展的分配政策和计划标准制定的MTCP资助烟草治疗服务。 第二阶段是对参与MTCP倡议的社区卫生服务机构进行前瞻性比较案例研究，以确定政策和标准与烟草治疗服务实施的关系。 数据将通过两种类型的方法获得：（1）定性方法，包括公共文件的内容分析，以及在州、社区和组织层面的关键知情人访谈;（2）定量方法，包括：对社区卫生服务管理者和临床医生、TTS和社区知情人的结构化调查;社区卫生服务监测数据;标准化病人和观察员填写的治疗检查表，以评价所提供的治疗服务的质量。 这些数据将用于调查与计划实施相关的因素，如通过CHS提供的烟草处理服务的数量、所提供服务的质量（即，应用实践标准的程度），服务范围（即，社区卫生服务和周边社区的渗透程度），以及实施烟草治疗相关系统，以支持社区卫生服务内的服务。收集的历史和前景信息将归纳为两份报告。 第一份报告将描述1994年至2000年的供资政策和方案标准的制定情况;社区卫生服务机构收到或没有收到供资的过程;然后，如果得到供资，用于实施烟草治疗方案的过程。 本报告将为考虑采取类似政策的其他国家提供建议。第二份报告将总结持续的政策制定情况和在社区卫生服务机构成功实施该方案的相关因素。 将提出建议，说明应将哪些标准纳入供资政策，以确保在不同类型的环境中成功实施烟草治疗计划和服务。

The recent tobacco settlements in 48 states will challenge state Departments of Public Health and other agencies to develop and implement public and organizational policies intended to prevent, control and treat tobacco use. The nationally-recognized Massachusetts Tobacco Control Program (MTCP), the largest, single purpose public health initiative in the nation, includes tobacco treatment services provided primarily through tobacco treatment specialists (TTSs) housed within community health settings (CHSs). The goal of this study is to evaluate present Massachusetts state policy designed to make effective tobacco treatment services available to a wide group of adult tobacco users, especially those at greatest risk (e.g., underserved, low income, industry-targeted minority groups), and to inform future policy. The proposed study is divided into two phases. Phase I is a descriptive case study of the longitudinal development of allocative policies and program standards developed by the MTCP for funding tobacco treatment services. Phase II is a prospective comparative case study of CHSs participating in MTCP initiatives to determine the relationship of the policy and standards to implementation of tobacco treatment services. Data will be obtained via two types of methods: (1) qualitative methods, including content analysis of public documents, and key informant interviews at the state, community and organizational level; and (2) quantitative methods including: structured surveys of CHS administrator and clinicians, TTSs and community informants; CHS monitoring data; and treatment checklists completed by standardized patients and by observers to evaluate quality of treatment services provided. These data will be used to investigate factors associated with program implementation, as measured by quantity of tobacco treatment services provided by CHSs, quality of services provided (i.e., the degree to which standards of practice are applied), reach of services (i.e., the degree of penetration into the CHS and surrounding community), and implementation of tobacco treatment-related systems to support the services within the CHS. The historical and prospective information gathered will be summarized into two reports. The first report will describe the funding policy and program standards development from 1994 to 2000; the process by which CHSs received, or did not receive, funding; and then, if funded, the process used to implement the tobacco treatment program. This report will provide recommendations for other states considering similar policies. The second report will summarize the continuing policy development and factors related to successful implementation of the program in CHSs. Recommendations will be made about what standards should be included in a funding policy in order to assure successful implementation of a tobacco treatment program and services in different types of settings.