From Good to Great: The Role of Performance Coaching in Enhancing Tobacco-Dependence Treatment Rates.

Abstract

The purpose of this study was to examine the incremental effect of performance coaching, delivered as part of a multicomponent intervention (Ottawa Model for Smoking Cessation [OMSC]), in increasing rates of tobacco-dependence treatment by primary care clinicians. In a cluster-randomized controlled trial, 15 primary care practices were randomly assigned to 1 of the following active-treatment conditions: OMSC or OMSC plus performance coaching (OMSC+). All practices received support to implement the OMSC. In addition, clinicians in the OMSC+ group participated in a 1.5-hour skills-based coaching session and received an individualized performance report. All clinicians and a cross-sectional sample of their patients were surveyed before and 4 months after introduction of the interventions. The primary outcome measure was rates of tobacco-dependence treatment strategy (<i>Ask</i>, <i>Advise</i>, <i>Assist</i>, <i>Arrange</i>) delivery. Secondary outcomes were patient quit attempts and smoking abstinence measured at 6 months' follow-up. Primary care clinicians (166) and patients (1,990) were enrolled in the trial. Clinicians in the OMSC+ group had statistically greater rates of delivery for <i>Ask</i> (adjusted odds ratio [AOR] = 1.69; 95% CI, 1.05-2.72), <i>Assist</i> (AOR = 1.64; 95% CI, 1.08-2.49), and <i>Arrange</i> (AOR = 2.01; 95% CI, 1.22-3.31). Sensitivity analysis found that the rate of delivery for <i>Advise</i> was greater only among those clinicians who attended the coaching session (AOR = 1.65; 95% CI, 1.10-2.49; <i>P</i> = .02). No differences were documented between groups for cessation outcomes. Performance coaching significantly increased rates of tobacco-dependence treatment by primary care clinicians when delivered as part of a multicomponent intervention.