The Medi-Cal Incentives to Quit Smoking Project: Impact of Statewide Outreach Through Health Channels

Elisa K. Tong, Susan L. Stewart, Dean Schillinger, Maya Vijayaraghavan, Melanie S. Dove, Anna E. Epperson, Cynthia Vela, Susan Kratochvil, Christopher M. Anderson, Carrie A. Kirby, Shu Hong Zhu, Jessica Safier, Gordon Sloss, Neal D. Kohatsu

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Introduction: Little is known about how incentives may encourage low income smokers to call for quitline services. This study evaluates the impact of outreach through health channels on California Medicaid (Medi-Cal) quitline caller characteristics, trends, and reach. Study design: Longitudinal study. Setting/participants: Medi-Cal quitline callers. Intervention: Statewide outreach was conducted with health providers, Medi-Cal plans (all-household mailings with tracking codes), and public health organizations (March 2012–July 2015). For incentives, Medi-Cal callers could ask for a $20 gift card; in September 2013, callers were offered free nicotine patches. Main outcome measures: Caller characteristics were compared with chi-square analyses, joinpoint analysis of call trends was performed accounting for Medi-Cal population growth, referral source among Medi-Cal and non–Medi-Cal callers was documented, and the annual percentage of the population reached who called the Helpline was calculated. Analyses were conducted 2016–2018. Results: Total Medi-Cal callers were 92,900, a 70% increase from prior annual averages: 12.4% asked for the financial incentive, 17.3% reported the mailing code, and 73.3% received nicotine patches while offered. Among the two thirds of callers who completed counseling, 15.5% asked for the financial incentive, and 13.6% reported the mailing code. A joinpoint analysis showed call trends increased 23% above expected for the Medi-Cal population growth after mailings to providers and members began, and decreased after outreach ended. Annual reach increased from 2.3% (95% CI=2.1, 2.6) in 2011 to peak at 4.5% (95% CI=3.6, 5.3) in 2014. Among subgroups with higher reach rates, some also had higher rates of asking for the financial incentive (African Americans, American Indian), reporting the tracking code (whites), or both (aged 45–64 years). Medi-Cal callers were more likely than non–Medi-Cal callers to report providers (32.3% vs 23.8%) and plans (19.7% vs 1.4%) as their referral source, and less likely to cite media (20.2% vs 44.4%, p<0.001). Conclusions: Statewide outreach through health channels incentivizing Medi-Cal members increased the utilization and reach of quitline services. Supplement information: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

Original languageEnglish (US)
Pages (from-to)S159-S169
JournalAmerican Journal of Preventive Medicine
Volume55
Issue number6
DOIs
StatePublished - Dec 1 2018

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Motivation
Smoking
Tobacco Use Cessation Products
Health
Population Growth
Medicaid
Referral and Consultation
Public Health
Gift Giving
North American Indians
Smoking Cessation
African Americans
Population
Longitudinal Studies
Counseling
Outcome Assessment (Health Care)
Organizations

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

The Medi-Cal Incentives to Quit Smoking Project : Impact of Statewide Outreach Through Health Channels. / Tong, Elisa K.; Stewart, Susan L.; Schillinger, Dean; Vijayaraghavan, Maya; Dove, Melanie S.; Epperson, Anna E.; Vela, Cynthia; Kratochvil, Susan; Anderson, Christopher M.; Kirby, Carrie A.; Zhu, Shu Hong; Safier, Jessica; Sloss, Gordon; Kohatsu, Neal D.

In: American Journal of Preventive Medicine, Vol. 55, No. 6, 01.12.2018, p. S159-S169.

Research output: Contribution to journalArticle

Tong, EK, Stewart, SL, Schillinger, D, Vijayaraghavan, M, Dove, MS, Epperson, AE, Vela, C, Kratochvil, S, Anderson, CM, Kirby, CA, Zhu, SH, Safier, J, Sloss, G & Kohatsu, ND 2018, 'The Medi-Cal Incentives to Quit Smoking Project: Impact of Statewide Outreach Through Health Channels', American Journal of Preventive Medicine, vol. 55, no. 6, pp. S159-S169. https://doi.org/10.1016/j.amepre.2018.07.031
Tong, Elisa K. ; Stewart, Susan L. ; Schillinger, Dean ; Vijayaraghavan, Maya ; Dove, Melanie S. ; Epperson, Anna E. ; Vela, Cynthia ; Kratochvil, Susan ; Anderson, Christopher M. ; Kirby, Carrie A. ; Zhu, Shu Hong ; Safier, Jessica ; Sloss, Gordon ; Kohatsu, Neal D. / The Medi-Cal Incentives to Quit Smoking Project : Impact of Statewide Outreach Through Health Channels. In: American Journal of Preventive Medicine. 2018 ; Vol. 55, No. 6. pp. S159-S169.
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abstract = "Introduction: Little is known about how incentives may encourage low income smokers to call for quitline services. This study evaluates the impact of outreach through health channels on California Medicaid (Medi-Cal) quitline caller characteristics, trends, and reach. Study design: Longitudinal study. Setting/participants: Medi-Cal quitline callers. Intervention: Statewide outreach was conducted with health providers, Medi-Cal plans (all-household mailings with tracking codes), and public health organizations (March 2012–July 2015). For incentives, Medi-Cal callers could ask for a $20 gift card; in September 2013, callers were offered free nicotine patches. Main outcome measures: Caller characteristics were compared with chi-square analyses, joinpoint analysis of call trends was performed accounting for Medi-Cal population growth, referral source among Medi-Cal and non–Medi-Cal callers was documented, and the annual percentage of the population reached who called the Helpline was calculated. Analyses were conducted 2016–2018. Results: Total Medi-Cal callers were 92,900, a 70{\%} increase from prior annual averages: 12.4{\%} asked for the financial incentive, 17.3{\%} reported the mailing code, and 73.3{\%} received nicotine patches while offered. Among the two thirds of callers who completed counseling, 15.5{\%} asked for the financial incentive, and 13.6{\%} reported the mailing code. A joinpoint analysis showed call trends increased 23{\%} above expected for the Medi-Cal population growth after mailings to providers and members began, and decreased after outreach ended. Annual reach increased from 2.3{\%} (95{\%} CI=2.1, 2.6) in 2011 to peak at 4.5{\%} (95{\%} CI=3.6, 5.3) in 2014. Among subgroups with higher reach rates, some also had higher rates of asking for the financial incentive (African Americans, American Indian), reporting the tracking code (whites), or both (aged 45–64 years). Medi-Cal callers were more likely than non–Medi-Cal callers to report providers (32.3{\%} vs 23.8{\%}) and plans (19.7{\%} vs 1.4{\%}) as their referral source, and less likely to cite media (20.2{\%} vs 44.4{\%}, p<0.001). Conclusions: Statewide outreach through health channels incentivizing Medi-Cal members increased the utilization and reach of quitline services. Supplement information: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.",
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T2 - Impact of Statewide Outreach Through Health Channels

AU - Tong, Elisa K.

AU - Stewart, Susan L.

AU - Schillinger, Dean

AU - Vijayaraghavan, Maya

AU - Dove, Melanie S.

AU - Epperson, Anna E.

AU - Vela, Cynthia

AU - Kratochvil, Susan

AU - Anderson, Christopher M.

AU - Kirby, Carrie A.

AU - Zhu, Shu Hong

AU - Safier, Jessica

AU - Sloss, Gordon

AU - Kohatsu, Neal D.

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N2 - Introduction: Little is known about how incentives may encourage low income smokers to call for quitline services. This study evaluates the impact of outreach through health channels on California Medicaid (Medi-Cal) quitline caller characteristics, trends, and reach. Study design: Longitudinal study. Setting/participants: Medi-Cal quitline callers. Intervention: Statewide outreach was conducted with health providers, Medi-Cal plans (all-household mailings with tracking codes), and public health organizations (March 2012–July 2015). For incentives, Medi-Cal callers could ask for a $20 gift card; in September 2013, callers were offered free nicotine patches. Main outcome measures: Caller characteristics were compared with chi-square analyses, joinpoint analysis of call trends was performed accounting for Medi-Cal population growth, referral source among Medi-Cal and non–Medi-Cal callers was documented, and the annual percentage of the population reached who called the Helpline was calculated. Analyses were conducted 2016–2018. Results: Total Medi-Cal callers were 92,900, a 70% increase from prior annual averages: 12.4% asked for the financial incentive, 17.3% reported the mailing code, and 73.3% received nicotine patches while offered. Among the two thirds of callers who completed counseling, 15.5% asked for the financial incentive, and 13.6% reported the mailing code. A joinpoint analysis showed call trends increased 23% above expected for the Medi-Cal population growth after mailings to providers and members began, and decreased after outreach ended. Annual reach increased from 2.3% (95% CI=2.1, 2.6) in 2011 to peak at 4.5% (95% CI=3.6, 5.3) in 2014. Among subgroups with higher reach rates, some also had higher rates of asking for the financial incentive (African Americans, American Indian), reporting the tracking code (whites), or both (aged 45–64 years). Medi-Cal callers were more likely than non–Medi-Cal callers to report providers (32.3% vs 23.8%) and plans (19.7% vs 1.4%) as their referral source, and less likely to cite media (20.2% vs 44.4%, p<0.001). Conclusions: Statewide outreach through health channels incentivizing Medi-Cal members increased the utilization and reach of quitline services. Supplement information: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

AB - Introduction: Little is known about how incentives may encourage low income smokers to call for quitline services. This study evaluates the impact of outreach through health channels on California Medicaid (Medi-Cal) quitline caller characteristics, trends, and reach. Study design: Longitudinal study. Setting/participants: Medi-Cal quitline callers. Intervention: Statewide outreach was conducted with health providers, Medi-Cal plans (all-household mailings with tracking codes), and public health organizations (March 2012–July 2015). For incentives, Medi-Cal callers could ask for a $20 gift card; in September 2013, callers were offered free nicotine patches. Main outcome measures: Caller characteristics were compared with chi-square analyses, joinpoint analysis of call trends was performed accounting for Medi-Cal population growth, referral source among Medi-Cal and non–Medi-Cal callers was documented, and the annual percentage of the population reached who called the Helpline was calculated. Analyses were conducted 2016–2018. Results: Total Medi-Cal callers were 92,900, a 70% increase from prior annual averages: 12.4% asked for the financial incentive, 17.3% reported the mailing code, and 73.3% received nicotine patches while offered. Among the two thirds of callers who completed counseling, 15.5% asked for the financial incentive, and 13.6% reported the mailing code. A joinpoint analysis showed call trends increased 23% above expected for the Medi-Cal population growth after mailings to providers and members began, and decreased after outreach ended. Annual reach increased from 2.3% (95% CI=2.1, 2.6) in 2011 to peak at 4.5% (95% CI=3.6, 5.3) in 2014. Among subgroups with higher reach rates, some also had higher rates of asking for the financial incentive (African Americans, American Indian), reporting the tracking code (whites), or both (aged 45–64 years). Medi-Cal callers were more likely than non–Medi-Cal callers to report providers (32.3% vs 23.8%) and plans (19.7% vs 1.4%) as their referral source, and less likely to cite media (20.2% vs 44.4%, p<0.001). Conclusions: Statewide outreach through health channels incentivizing Medi-Cal members increased the utilization and reach of quitline services. Supplement information: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

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