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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Smoking During Pregnancy.

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Strategy. Health Care Provider Reminder Systems for Tobacco Cessation (Pregnancy)

Approach. Support the implementation of health care provider reminder systems within primary care and women's health clinics

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Overview. Provider reminder systems are intended to remind or encourage health professionals to support tobacco cessation among their patients. Such systems can include provider trainings, organizational protocols for providing referrals, financial remuneration for providers, self-help materials, and access to pharmacotherapy (e.g., nicotine replacement therapy (NRT)).[1,2,3]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Provider training and education records
  • Reminder system utilization data (clinic-reported)
  • Qualitative feedback from providers and staff

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of primary care and women's health clinics that implement provider reminder systems. (Measures adoption of systems to support cessation)
  • Number of patient visits in which tobacco cessation is addressed due to reminder prompts. (Quantifies the frequency of cessation support delivery)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of provider reminder systems that adhere to clinical guidelines for tobacco cessation. (Evaluates alignment with evidence-based best practices)
  • Percent of patient visits with tobacco users that include cessation support. (Assesses consistency of intervention delivery when indicated)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of health systems that integrate tobacco cessation reminders into electronic health records. (Promotes sustainability and spread of the intervention)
  • Number of provider incentive programs established to encourage delivery of tobacco cessation services. (Leverages financial drivers to boost intervention delivery)
  • Number of individuals who smoke who make a quit attempt after receiving cessation support from their provider. (Demonstrates the impact of reminders on patient behavior change)
  • Number of individuals who quit smoking during pregnancy after their provider addresses cessation. (Shows impact on a high-focus population for intervention)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of provider reminder systems that incorporate tailored cessation resources. (Ensures relevance and appropriateness for all patient populations)
  • Percent of providers that receive data feedback on their tobacco cessation activities. (Facilitates continuous quality improvement and accountability)
  • Percent decrease in smoking prevalence among reproductive-age individuals after widespread provider reminder implementation. (Evaluates population health impact)
  • Percent of Medicaid expenditures on smoking-related illnesses that are averted by provider cessation interventions. (Assesses healthcare cost savings)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Rosseel, J., Jacobs, J., Plasschaert, A., & Grol, R. (2012). A review of strategies to stimulate dental professionals to integrate smoking cessation interventions into primary care. Community Dental Health, 29(2), 154–161.

2 Benjamin, N., Choubey, V., Bhasin, M., Sushma, B., Choudhary, A., & Thomas, P. A. (2024). Analysis of tobacco cessation programs in dental settings. Journal of Pharmacy & Bioallied Sciences, 16(Suppl 4), S3290–S3292. https://doi.org/10.4103/jpbs.jpbs_710_24

3 Tvina, A., Tillis, B., Chen, M., MacBeth, M., Tsaih, S. W., & Palatnik, A. (2024). Effect of a best-practice alert on the rate of smoking cessation among pregnant women. American Journal of Perinatology, 41(S 01), e1901–e1907. https://doi.org/10.1055/a-2091-5643

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.