number of people who are counseled to quit using tobacco by their health-care providers, the number of people who quit at some time after using an intervention, or the number and types of policies aimed at achieving tobacco control.

Progress in tobacco-use cessation treatment at the population level can be known because of metrics that are tied to resources (Curry et al., 2006, 2008). Some metrics consist of straightforward information about investment in state and national mass-media campaigns to promote smoking cessation and use of evidence-based treatments, such as state quitlines. Other metrics are indicators of the coverage of tobacco-cessation interventions in federal insurance plans (such as Medicare and Medicaid) and employer-sponsored insurance (Bondi et al., 2006). With support from the Robert Wood Johnson Foundation, several national surveys of managed-care coverage for tobacco-cessation services have been conducted (McPhillips-Tangum et al., 2006), but funding for those surveys has ended. The National Committee for Quality Assurance (NCQA, 2008) report The State of Health Care Quality 2007 states that counseling smokers to quit increases the likelihood that they will do so and is a cost-effective intervention. Interventions such as discussing tobacco-cessation strategies and the use of NRTs increase the potential for smoking cessation. NCQA has a quality measure for medical assistance with smoking cessation that consists of three components: advising smokers to quit, discussing smoking-cessation medications, and discussing smoking-cessation strategies. NCQA has recently proposed revising the Health Plan Employer Data and Information Set measure for 2010 to include other tobacco products, such as pipes, snuff, and chew (NCQA, 2008).

Those measures allow tracking of patients’ reports of whether their physicians have advised them quit and offered behavioral and pharmacologic treatments. Inpatient metrics derive from the Joint Commission accreditation measures of the number of inpatients that receive advice or counseling for smoking cessation during their hospital stays. These metrics are a core measure for assessing the treatment of acute myocardial infarction, congestive heart failure, and pneumonia. The National Quality Forum nursing-sensitive care measures include nursing-centered interventions for smoking cessation (Robert Wood Johnson Foundation, 2008). The Agency for Healthcare Research and Quality’s annual National Healthcare Quality Report includes measures related to primary-care provider advice to quit for all smokers over 18 years old during routine office visits and post–myocardial infarction counseling to quit smoking (HHS, 2007).

Health-care system metrics related to front-line clinical practice are complemented by individual-level data from national surveys, such



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