Figure 3
How the integrated QUIT-PRIMO is conceptualized to improve processes of care (5 A s) and increase smoking cessation: use of the clinical microsystem intervention over time by one example practice and one patient. A1: Ask--ReferaSmoker sends email prompts to providers reminding them of the importance of smoking cessation; provider downloads printable chart stickers, etc., to increase systematic screening by nurses. A2: Advise-- ReferaSmoker materials provide additional knowledge to providers on strong advice; provider advises patient. A3: Assess-- Provider explains content of Decide2Quit and assesses willingness of patient to use system and to quit. A4: Assist-- Patient agrees to be recruited and nurse enters patient email into ReferaSmoker online portal and patient is enrolled into the system. Decide2Quit sends email reminders to the patient. Patient uses system and talks to family because of the motivational messages. A4: Assist-- Patient engages in the online support group, shares his quitting experiences and finds others with similar experiences, posts a question online, and interacts with other smokers trying to quit. A4: Assist-- Patient selects a tobacco treatment specialist (TTS) and posts a question to her using the MyMail feature of the system. The TTS responds with helpful suggestions, and the patient returns to the system to read her responses. A4: Assist-- Patient continuously receives tailored "advice" emails from the system. Emails are from experts and peers. A5: Arrange-- Nurse (and/or physician) reviews reports of patient use and follows up. Nurse sends a template-driven email message encouraging use of the system and offering treatment. A4: (more) Assist--Patient returns to Decide2Quit repeatedly, is increasingly motivated, requests treatments → quits.