Tobacco use causes approximately 480,000 deaths each year in the U.S. and takes an annual economic toll of nearly $300 billion. Smoking cessation can slow the decline in lung function, improve prognosis in patients with coronary obstructive pulmonary disease, and reduce the risk of cancer and stroke. To increase long-term cessation rates, the Joint Commission (JC) recommends that all hospitalized smokers receive tobacco cessation services as an inpatient and followup within 1 month post-discharge. Few hospitals implement the standard, in part because the services impose extra costs and the financial benefits to hospitals and insurers are unclear. However, health information technology can provide an inexpensive way to meet the JC standards.

This study examined the effect of an interactive voice recognition (IVR)-driven tobacco dependence treatment service (TDTS) that operationalized the JC standards. Researchers used an in-place data capture mechanism that allows efficient linkage between the hospital electronic health record system, cessation program, and statewide healthcare utilization data sets. They examined monthly trends in readmission rates before and after program implementation, testing the hypothesis that an automated inpatient smoking cessation program would reduce unplanned readmissions and healthcare costs.

The specific aims of the project were as follows:

• Examine the inpatient hospital cessation program effect on hospital readmission, both on an overall population of patients and for those with Centers for Medicare & Medicaid Services’ readmission penalty conditions. 
• Calculate the inpatient hospital cessation program costs and potential cost savings. 

The study included acute care patients identified as smokers admitted and discharged from the Medical University of South Carolina hospital between November 1, 2014, and June 31, 2015. A bedside tobacco cessation specialist visited patients during their hospitalization to assess their nicotine dependence and developed a treatment plan. IVR followup was conducted 3, 14, 30, 90 and 180 days after hospital discharge.

At 30 days post-discharge, smokers exposed to the TDTS were significantly less likely to be readmitted to the hospital compared to smokers who did not receive the intervention. At 90 and 180 days, odds of readmission remained lower in the TDTS group, but were not statistically significant. The average savings per smoker exposed to the TDTS was $7,299. The TDTS cost per smoker was modest by comparison at $34.21 per smoker. If extrapolated out (to the healthcare system, the U.S.), full implementation could save between $3.6 and $4.8 million, accounting for the cost of program delivery and cost savings per patient.