Defining Patient Impact
As Global Bridges grantees continue their work to treat tobacco dependence and work toward policy change, they also aim to estimate the impact of healthcare provider training as part of evaluating program effectiveness.
During September’s grantee call, Moore’s Seven Levels of CME Outcomes were mentioned as a basis for measuring healthcare providers’ learning and implementation. Currently, most Global Bridges grantees are evaluating at Level 4 (learning – shows how.) Ultimately, we strive to reach Levels 6 and 7 – achieving patient health and full population health, respectively. A significant resource would be needed to actually follow patients and record their activity after their interaction with a trained healthcare professional, some estimation is required.
With this in mind, Dr. Gustavo Zabert, regional director for Latin America at Global Bridges, presented a method he developed to estimate the impact on patients of healthcare providers’ work. Though the method requires that a number of real-world associations be made for a formal estimation, Dr. Zabert’s formula can help us understand the increased impact healthcare professionals may have following training in smoking cessation support.
The “Zabert Doctrine” multiplies the number of healthcare providers trained in 2012 by each working day (240) to determine the number of smokers who received brief advice (Figure 1, below.) Based on his calculation and average effectiveness of brief advice per the Cochrane Review, Dr. Zabert estimated 5,538 patients were smoke-free after a brief advice, as pictured in Figure 1 (The Cochrane Review defines “quitter” as a nonsmoker after six months.)
Dr. Zabert also took the formula a step further, noting that a brief advice is not always the cause of a smoker’s decision to quit. He posed another question: What if 1/5 (or 20 percent) of the remaining smokers received nicotine replacement therapy (NRT) and intensive intervention (IT) the following year? Figure 2 depicts his process: beginning by isolating the number of smokers who have not yet quit, then multiplying it by 20 percent to calculate the number of smokers who would receive NRT and IT. He then multiplied that number by a 12 percent abstinence rate to determine the number of smoke-free patients resulting from NRT and IT: 5,184.
Combined with the results from the formula in Figure 1, Dr. Zabert estimated 10,722 patients quit smoking in 2013 following interaction with a Global Bridges-trained healthcare provider. Keeping in mind the necessary assumptions, an estimate of patient impact is an important component in benchmarking the success and effectiveness of Global Bridges programs for healthcare providers.