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The Roadmap for Clinical Quality at Group Health Cooperative (GHC) of Puget Sound is a patient-focused, population-based, systematic, organizational effort designed to identify and improve key clinical processes for GHC enrollees. The underlying premise is that by improving clinical care processes and decreasing unnecessary practice variation, health, cost and patient satisfaction outcomes will improve, thereby increasing the value of the GHC product. Key clinical processes targeted for system-wide improvement are those for which there is demonstrable evidence that improving the care process will result in improved health outcomes and/or decreased cost.

Background: The purpose of this study was to assess nicotine gum use when prescribed in a nonresearch, routine outpatient setting. Special attention was given to comparing actual use patterns with established guidelines for use based on clinical research., Methods: A randomly selected group of 612 patients who had received a prescription for nicotine gum during an 18-month period were surveyed regarding their smoking history and use of the gum., Results: Most of the gum prescriptions (75%) were requested by patients rather than recommended by medical care providers. Less than one half of the users were heavy smokers. The reported amount of gum used was small, with more than one half reporting consumption of one box or less, and about one third reporting use of the gum for only 1 week or less. Larger amounts of gum use, however, were associated with abstinence from tobacco. Only one in 20 users attended a structured behavioral treatment program while using the gum. Over one half of the patients reported using nicotine gum to help them cut down on, rather than quit, smoking., Conclusions: Only a small percentage of the patients used the nicotine gum according to the established guidelines, and most of the patients used the gum in ways that have been shown to be ineffective for smoking cessation. Providers should educate their patients in the techniques that maximize the use and effectiveness of nicotine gum in smoking cessation.