VISN

Hospitals and Medical Centers

CBOCs

Other Outpatient Clinics

Veterans Centers

Other Facilitiesb

VISN 19: Rocky Mountain

6c

37

2

14

0

VISN 20: Northwest

9c

26

1

15

2

VISN 21: Sierra Pacific

8

9

26

20

0

VISN 22: Desert Pacific

5

29

5

11

1

VISN 23: Midwest

12

40

3

14

0

Total

170

576

144

251

6

a As of April 10, 2009.

b Includes domiciliaries, federal hospitals, rehabilitation facilities, PTSD clinics, and care facilities.

c Includes at least one VA health-care system in addition to the medical centers.

SOURCE: Adapted from VA (2009b).

The VISN administrators are responsible for implementing the many policies and programs for health-care services in the hospitals and clinics in each VISN, including tobacco-use cessation. Although the VISN administrators report to the deputy under secretary for health for operations and management, they have substantial autonomy and authority for the medical services offered within their own VISNs, including tobacco control. They can be instrumental in emphasizing tobacco-cessation activities at all of their medical facilities.

Virtually all of the VAMCs have some form of tobacco-control program although the programs are not standardized or uniform (VA, 2006b). The agency’s 2005 report Smoking and Tobacco Use Cessation indicated that although 99% of the facilities included in a survey had tobacco-control programs, they varied in who managed the programs, who was responsible for documenting patients’ smoking status in the electronic medical records, who could prescribe medications, and whether they accommodated special populations, such as women, inpatient psychiatric patients, and hospitalized patients (VA, 2006b).

There is even greater variation among the CBOCs’ tobacco-control services, although each one is affiliated with a specific VAMC. CBOCs were established in the 1990s to provide access to, and continuity of care for, underserved veteran populations, many of them in



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