POLICY TO SUPPORT TOBACCO TREATMENT IN HEALTH CARE

最近在48个州达成的烟草和解将挑战州公共卫生部门和其他机构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。国家认可的马萨诸塞州烟草控制规划（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（CHSs）内的烟草治疗专家（TTSs）提供的烟草治疗服务。本研究的目的是评估马萨诸塞州目前的政策，该政策旨在为广大成年烟草使用者提供有效的烟草治疗服务，特别是那些风险最大的群体（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。建议的研究分为两个阶段。第一阶段是对MTCP为资助烟草治疗服务而制定的分配政策和项目标准的纵向发展进行描述性案例研究。第二阶段是参与MTCP倡议的卫生保健中心的前瞻性比较案例研究，以确定政策和标准与实施烟草处理服务的关系。数据将通过两种方法获得：(1)定性方法，包括公共文件的内容分析，以及国家、社区和组织层面的关键线人访谈；(2)定量方法，包括：对卫生服务管理人员、临床医生、tss和社区举报人进行结构化调查；CHS监测数据；以及由标准化患者和观察员完成的治疗检查表，以评估所提供的治疗服务的质量。这些数据将用于调查与规划实施有关的因素，如卫生保健中心提供的烟草处理服务的数量、提供的服务的质量（即实施实践标准的程度）、服务的覆盖范围（即卫生保健中心和周围社区的渗透程度）以及为支持卫生保健中心内的服务而实施的烟草处理相关系统。所收集的历史和未来信息将总结成两份报告。第一份报告将描述1994年至2000年的资助政策和项目标准的发展；健康护理中心获得或未获得资助的程序；然后，如果得到资助，这个过程将用于实施烟草治疗项目。这份报告将为其他考虑类似政策的州提供建议。第二份报告将总结持续的政策发展和与在卫生保健中心成功实施该方案有关的因素。将就筹资政策应包括哪些标准提出建议，以确保在不同类型的环境中成功实施烟草治疗规划和服务。

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.