Furthermore, data on performance measures, the number of veterans who smoke, types of tobacco-cessation treatments available and their use, and costs and benefits of the programs are maintained in a variety of VA offices and facilities. Such scattering of the dataset makes evaluation of tobacco-control efforts difficult and opaque. The cost of treating veterans for tobacco use is comparatively small compared with the cost of treating veterans for tobacco-related diseases (Jonk et al., 2005), but the efficacy of the tobacco-cessation treatments is unclear. Without systematic and periodic evaluation of the outcomes of VA’s tobacco-cessation efforts, it is impossible for it to modify programs for maximum effectiveness or to introduce new and perhaps more successful approaches. The committee notes that VA does prepare an annual Performance and Accountability Report that includes a Clinical Practice Guidelines Index measure. This composite measure comprises “the evidence and outcomes-based measures for high-prevalence and high-risk diseases that have significant impact on overall health status. The indicators within the Index are comprised of several clinical practice guidelines in the areas of ischemic heart disease, hypertension, diabetes mellitus, major depressive disorder, schizophrenia, and tobacco use cessation…. The measure demonstrates the degree to which VA provides evidence-based clinical interventions to veterans seeking care in VA. The measure targets elements of care that are known to have a positive impact on the health of our patients who suffer from commonly occurring acute and chronic illnesses” (VA, 2008d). The measure, however, does not specifically report annual compliance with the VA/DoD Clinical Practice Guideline for the Management of Tobacco Use.

Finding: The VA does conduct periodic surveys of its tobacco-cessation programs, but it has no central repository of information about the nature and implementation of tobacco-cessation activities. There is a lack of information about which treatment methods have been most sought by veterans and which have been most effective in enabling veterans to cease tobacco use.

Recommendation: The VA should assess the reach and effectiveness of its tobacco-cessation programs.

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