Featured Practice: Central Nephrology Clinic – Using Small Tests of Change to Increase Tobacco Screenings


Central Nephrology Clinic (CNC) is a practice that exemplifies the ideals of the practice transformation. By using quality improvement methodologies and small tests of change, this nephrology practice has significantly increased patient tobacco screenings, an area that some wouldn’t even consider within this speciality practice’s scope of work. Practice transformation is about just that– using sound methods to deliver comprehensive, robust, efficient healthcare. 

CNC was founded in Flowood, Mississippi in 1978. This multispecialty practice provides a full spectrum of acute and chronic kidney care for patients with kidney disease, transplants, and hypertension. The practice began its transformation journey to add value to every patient visit by providing holistic care through education, communication, and technology. 

Tobacco use is not a new phenomena, and while the health consequences for lung cancer are well documented, it is perhaps less known that smoking can exacerbate kidney disease, too. Prior to joining TPCI, the practice was not systematically screening patients for tobacco use. They organized a change team to oversee QI strategies and began a Plan-Do-Study-Act cycle by adding a best practice alert in the workflow to flag patients in need of a screening. Medical Assistants were trained to administer the screening during each patient visit, and if they identified positive screening, the results were passed to the provider to share cessation resources and counsel.   

CNC, and its patients, have benefitted from these changes. Tobacco screenings and cessation interventions have jumped from 65% to 96% over two years. This simple change story shows the benefits that can be earned from practicing as a team, empowering staff to practice to the top of their credentials, and using data driven approaches to create sustainable change. You can read more about Central Nephrology Clinic’s story at this link

Quality improvement is about not being afraid to try new things and nurturing that change mindset and culture among providers, staff, administrators, patients and families. But this transformation mindset is not a given, and many practices need to earn buy-in from their care teams. In this week’s “Best Practices” Podcast, we discuss a new resource — Value Based Care University — which will provide resources and training on quality improvement in today’s healthcare environment. Take a listen to learn about this exciting new initiative!    

The views expressed in this story are those of the authors and do not necessarily represent the official views of Central Nephrology Clinic. Additionally, this work was funded by the U.S. Department of Health and Human Services – Centers for Medicare and Medicaid Services’ Transforming Clinical Practice Initiative, under grant number 1CMS331549-03-00. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.


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