3 Use of 5As If a primary 90% of Tools that have Tools where with caregiver screens caregivers the provider, is “Yes” smoking positive for who advising, selected for caregivers smoking in screen assisting, Question 10 question 10, the positive arranging: --AND-- provider will for Tools where “Yes” utilize the 5As smoking selected for Question 15 smoking cessation in the has a response MD plan provider home greater than discussed – will advise, assist setting zero to smoking by providing will have cigarettes, “Yes” cessation received selected for cigars/blacks resources and the 5As & milds and/or caregiver arrange a Quitline plan to smoking referral (if quit packet given caregiver smoking AND pens/hookah in indicates or the last 7 days “Yes” readiness and “No- willingness) Declined” selected for * Percent of MD faxed presenting referral to smoking Quitline caregivers who All of the receive the 5A’s above need Intervention to be satisfied in order to selected to “Yes” Were all 5A steps completed during this visit 4 Referrals to When the primary > 90% of Tools that have Tools where Ohio QUIT smoking caregiver caregivers the provider, is “Yes” LINE for that is ready to who are advising, selected for Presenting quit smoking ready to assisting, Question 10 Caregiver (rating on quit arranging: --AND-- Question 21of smoking Tools where “Yes” is asked if will be selected for Question 15 2+), the PROVIDER asked has a response MD can fax a referral about a greater than discussed to the Ohio Quit referral to zero to smoking Line. The cigarettes,
3 Use of 5As with smoking caregivers If a primary caregiver screens positive for smoking in question 10, the provider will utilize the 5As smoking cessation plan – provider will advise, assist by providing cessation resources and arrange a Quitline referral (if caregiver indicates readiness and willingness) * Percent of presenting smoking caregivers who receive the 5A’s Intervention 90% of caregivers who screen positive for smoking in the home setting will have received the 5As plan to quit smoking Tools that have the provider, advising, assisting, arranging: “Yes” selected for MD discussed smoking “Yes” selected for caregiver smoking packet given AND “Yes” or “No- Declined” selected for MD faxed referral to Quitline All of the above need to be satisfied in order to selected “Yes” to Were all 5A steps completed during this visit Tools where “Yes” is selected for Question 10 --AND-- Tools where Question 15 has a response greater than zero to cigarettes, cigars/blacks & milds and/or pens/hookah in the last 7 days 4 Referrals to Ohio QUIT LINE for Presenting Caregiver When the primary smoking caregiver that is ready to quit smoking (rating on Question 21of 2+), is asked if the PROVIDER can fax a referral to the Ohio Quit Line. The > 90% of caregivers who are ready to quit smoking will be asked about a referral to Tools that have the provider, advising, assisting, arranging: “Yes” selected for MD discussed smoking Tools where “Yes” is selected for Question 10 --AND-- Tools where Question 15 has a response greater than zero to cigarettes,
SFF-Measures-Table-Collaborative-Use.docx