Update of the NAQC Minimal Data Set

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(No Transcript)
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Update of the NAQC Minimal Data Set

• Jessie E. Saul, Ph.D.
• Director of Research
• North American Quitline Consortium
• RaeAnne E. Davis, MSPH
• Co-chair
• MDS Assessment Workgroup
• Donna Czukar
• Director, Cancer Information and Support
• Canadian Cancer Society
• NAQC Conference Call Series, August 5 7, 2009

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Objectives

• Review the process for developing the MDS and
  conducting the MDS Update
• Explore the purpose of the Updated MDS
• Examine changes to the MDS
• Review implementation materials (Implementation
  Guidebook)
• Timeline and next steps

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PROCESS
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History of the MDS

• Began discussions about a Minimal Data Set in
  2003
• National Network of Quitlines and 1-800-QUIT NOW
  as the national portal number in 2004
• Funding from CDC to help all states
  create/improve QLs
• MDS designed to create common language among
  quitlines
• Finalized in May 2005
• Encouraged QLs to adopt in October 2005
• MDS consists of
• Intake questions
• Follow-up questions

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Standardization of Data

• Important to collect data using standardized and
  valid techniques
• Allows for comparison across quitlines
• Ability to pool data for research and evaluation
  purposes on a larger scale
• Helps to develop service benchmarks
• Scientific rigor in a relatively new field of
  cessation services
• Provides foundation for data collection with
  other cessation programs in states/provinces

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MDS Assessment

• One year after adoption, MDS workgroup reconvened
  to assess implementation
• Two-part assessment process of implementation
  and item-by-item assessment
• Final Report contains six recommendations
• Report available at

http//www.naquitline.org/Default.asp?pagetechnic
al
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MDS Update - Goals

• Avoid large-scale overhaul
• Work with NAQC members through workgroup to
  ensure all member stakeholder groups have voice
  in process
• Improve the tool for measuring quitline process
  and outcome measures
• Improve the fidelity of implementation of the MDS

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MDS Update - Process

• Start with Assessment report recommendations
• Identify problematic questions
• Align MDS items with new NAQC standards for
  calculating quit rates and reach
• Consult the literature and external experts
• Keep burden on quitlines as low as possible

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MDS Update - Workgroup

• Erik Augustson, NCI
• Esther Baker, Iowa Tobacco Research Center
• Frankie Best, Ministry of Healthy Living and
  Sport, BC, Canada
• Donna Czukar, Canadian Cancer Society Ontario
  Division
• RaeAnne Davis, Chair
• Marti Engstrom, CDC

• Judy Ochs, Division of Tobacco Prevention and
  Control, Pennsylvania
• David Tinkelman, National Jewish Health
• Jennifer Woodrow, Newfoundland and Labrador
  Smokers Helpline
• Susan Zbikowski, Free Clear, Inc.
• Barbara Zupko, CBRPE

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MDS Update - Process

• Monthly workgroup meetings
• Identified major issues from Assessment report
• Identified additional items for revision
• Prioritized technical assistance topics
• Reviewed proposed changes and rationale on each
  call
• Consulted with experts between calls
• Finalized TA materials

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PURPOSE
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Why Update the MDS?

• Improve consistency and clarity of the MDS
• Keep MDS consistent with updated survey methods
• Align MDS with new NAQC standard calculations for
  reach and quit rates
• Address member questions and concerns with
  original MDS

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Purpose of the Update

• Provide members with the best thinking on how to
  ask a core set of questions at intake and
  follow-up
• Provide material to serve as a starting point for
  discussions between funders and service providers
• Allow for continued collective improvement and
  standardization as a community of practice

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The Update is NOT

• a requirement for all quitlines
• an attempt to tell very smart people how to do
  their jobs
• a lot of changes for the sake of making changes

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Update Expectations

• Ideal scenario all quitlines implement exactly
  the same way
• Realistic expectations implementation will
  depend on
• Needs
• Resources
• Unique environment
• Updates will be made as a continual process
• NAQC to provide TA as needed and requested

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Our hopes for the Update

• Quitlines will view it as a tool to be used as
  best meets their needs
• Quitlines will take advantage of the opportunity
  to think critically about intake and follow-up
  questions
• Where possible, updates will be made to improve
  our collective ability to answer questions about
  quitlines

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CHANGES
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General changes

• Response categories more consistent and better
  defined
• Probes included to help increase data quality
• Clarification of when it is acceptable to assess
  a piece of information without directly asking a
  question (e.g., age, postal code)
• Some questions made optional

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Wording changes

• Do you smoke pipes? changed to Do you smoke a
  pipe?
• Chewing tobacco or snuff modified to Chewing
  tobacco, snuff, or dip

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Intake 2b

• 2005 MDS
• 2b. Are you
• A health professional
• A friend or family member
• A community organization, worksite, insurance
• Other __________

• 2009 MDS Update
• Optional 2b. Are you
• A health professional
• A friend or family member
• A community organization, worksite, insurance
• Other ___________

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Intake 3

• NAQC MDS Intake Question 3
• How did you hear about the quitline? (DO NOT
  READ CHECK ALL RESPONSES)
• MEDIA
• Newspaper
• Radio
• Television
• Internet/web
• Other selections can be added by quitline
• OTHER ADVERTISING
• Other selections can be added by quitline
• REFERRAL
• Other selections can be added by quitline
• Dont know
• Refused
• Not asked

• Internet/web added to Media
• Subcategories should be used as a starting point
• List of potential response categories on NAQC
  website. Updated monthly.
• For additional assistance, contact NAQC at
  naqc_at_naquitline.org.

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Types of tobacco use questions (Intake 5 series
Follow-up 2 series)

• What types of tobacco do you use now or in the
  past 30 days?

• Screener question for all types of tobacco
• Option 2 available to assess for cigarette use
  first, then other types later (appendix A)
• Asks about now or in the past 30 days

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Types of tobacco use questions (Intake 5 series
Follow-up 2 series)

• 5a-e Do you currently use TYPE of tobacco
  every day/daily, some days/occasionally, or not
  at all?

• Same question for cigarettes as original
• New questions for other types of tobacco
• Instructions to code lt1 cig/day etc. as some
  day/occasional smoker deleted

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Types of tobacco use questions (Intake 5 series
Follow-up 2 series)

• 5a-e(1) How many TYPE OF TOBACCO do you USE
  on the days/weeks that you USE?

• Same question for cigarettes as original
• New questions for other types of tobacco
• Instructions that lt1/day or lt1/week should be
  coded as some days/occasional in 5a-e deleted.

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Types of tobacco use questions (Intake 5 series)

• 5a-e(2) When was the last time you used TYPE of
  tobacco, even a puff/pinch?

• Same question for cigarettes as original
• New questions for other types of tobacco
• Coding of unknown responses changed, and probes
  added
• Critical question for quit rate calculation

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Time to first tobacco use

• NAQC MDS Optional Question 7 How soon after you
  wake up do you use tobacco (other than
  cigarettes)? (DO NOT READ)
• Within five minutes
• 6 to 30 minutes
• 31 to 60 minutes
• More than 60 minutes
• Dont know
• Refused
• Not asked

• New question for other tobacco products
• Validated measure for smokeless tobacco, but not
  for other types of tobacco
• Results should be interpreted with caution

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Age started using tobacco regularly

• Intake optional Q9b-e At what age did you start
  using TYPE of tobacco regularly?

• New questions for other types of tobacco
• Can be asked at intake or during counseling
  session

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Sample intro script for demographic questions

• Before we finish, I'd like to ask you some
  additional questions about yourself.  see
  script May I ask you these additional
  questions? (entire text on page 12 of the
  comparison document)

• Combination of several sample scripts
• Designed to provide an answer to why are you
  asking me these questions?
• Can be modified by quitlines as needed
• Can be used at different places in the process,
  depending on question order

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Education

• Clarified technical or trade school option for
  Canada response categories
• Some college, technical or trade school (includes
  any post-high school education, including
  technical or trade school, but not a degree)

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Race/Ethnicity - US

• Added or Spanish origin to ethnicity question
• Modified response categories to more closely
  match US Census
• Clarified intent is to provide multi-select
  option
• Priority should be on reporting in MDS categories
  recognizing some quitlines have good rationale
  for combining these two questions

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Race/Ethnicity - Canada

• 17a People living in Canada come from many
  different cultural and racial backgrounds. Are
  you (select all that apply)
• White, Asian, Black, Latin American, Arab,
  Aboriginal, Other

• New question
• Matches Canadian Census and Canadian Community
  Health Survey
• More closely matches US race question than
  original Canadian MDS race question

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Race/Ethnicity Canada (cont.)

• 17b (optional) Are you a member of an Indian
  Band/First Nation?
• 17c (optional) To which of the following ethnic
  or cultural groups did your ancestors belong?

• 17 b is a new question
• 17c is identical to the original MDS question for
  Canada. The Canadian census question does not
  list response categories (open response)

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Sexual Orientation

• Optional Intake Q18 Do you consider yourself to
  be one or more of the following say the letter
  and the response option so that they can respond
  by either one
• a) Straight
• b) Gay or Lesbian
• c) Bisexual
• d) Transgender
• IF pause or refusal/none of above, also say
• You can name a different category if that fits
  you better _____________________
• e) Other
• These are not read aloud, but are pre-coded as
  they were the most frequently chosen in our
  testing phase.
• Queer
• Genderqueer
• Dyke
• other

These are not read aloud, but are pre-coded as
they were the most frequently chosen in our
testing phase.
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Follow-up abstinence questions

• 30-day abstinence question (7)
• identical to original except for adding or
  pinch
• Critical item for calculating NAQC quit rate
• 7-day abstinence question (8)
• now optional
• Date of last use (9-10a-e)
• All tobacco together, or each type separately

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Use of other assistance

• ORIGINAL MDS
• 11. Since your call to the quitline on (Date of
  first contact), seven months ago, have you used
  anything to help you quit? For example, nicotine
  replacement (gum or patch), pills (Zyban), group
  cessation, advice from a health professional,
  self-help materials? (yes/no)
• 12. Optional What kind of treatments or health
  professionals?

• MDS UPDATE
• 11. Since you first called the quitline seven
  months ago, have you used any of the following
  products or medications to help you quit?
• 12. Other than the quitline or medications, did
  you use any other kinds of assistance to help you
  quit over the past seven months, such as advice
  from a health professional, or other kinds of
  quitting assistance?

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Administrative data

• Clarification provided regarding which items are
  to be reported and which are for internal
  quitline use
• Rationale provided for each item and how it might
  be used (annotated table, pages 35, 57)

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TECHNICAL ASSISTANCE MATERIALS
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Implementation Guide

• Access at www.naquitline.org, click on Research
  and Data Sets, then Minimal Data Set, then
  MDS Technical Documents

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Implementation Guide

• Introduction
• Updated intake and follow-up questions
• Side-by-side comparison (old vs. new)
• Annotated table
• What is the MDS? FAQs

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Additional Technical Assistance

• FAQs will be posted on the MDS Technical
  Documents page http//www.naquitline.org/?pagetec
  hnical
• Individual TA available upon request
  naqc_at_naquitline.org

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NEXT STEPS
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Rollout of MDS Update

• August 2009 soft launch
• August October 2009 Review, detailed feedback
  from volunteer quitlines, changes to materials
• November 2009 Hard launch and re-release of
  all materials
• November 2009 July 2010 Implementation of MDS
  Updates TA provided by NAQC by request
• July 2010 suggested target for full
  implementation

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Feedback from Members

• Are there MDS Update recommendations that are not
  clear?
• Do the technical assistance materials need to be
  changed?
• What additional materials/assistance would be
  most useful?
• As we go through the implementation process, what
  works and does not work?

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QUESTIONS AND COMMENTS
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Additional Information

• MDS Implementation Guide
• NEED WEB ADDRESS HERE
• Jessie Saul
• jsaul_at_naquitline.org
• RaeAnne Davis
• raeanne620_at_hotmail.com
• Donna Czukar
• Donna.Czukar_at_jcc.hhsc.ca
• NAQC Website
• www.NAQuitline.org