'Best' hospitals should be required to deliver tobacco treatment

A UCLA-led report published today in the Journal of the American Medical Association Internal Medicine exposes what the authors call a weakness in the high-profile "Best Hospitals Honor Roll" published annually by U.S. News and World Report.

The data used to compile the rankings are collected from multiple sources, including outcomes reported to the Joint Commission, an accreditation agency. Every three years, hospitals are required to complete a comprehensive review by the Joint Commission to earn or maintain accreditation.

None of the top 20 hospitals in the 2020-21 U.S. News rankings reported to the Joint Commission on how they deliver smoking cessation care and treatment for tobacco dependence -- which the paper calls a significant disconnect.

The authors suggest that reporting on tobacco treatment should be a required measure, not an elective one, for accreditation and recognition.

"An honor roll for best hospitals is missing the mark if these hospitals aren't helping smokers quit," said Linda Sarna, dean of the UCLA School of Nursing and the report's lead author. "The good news is that there are cost-effective treatments that work if health care providers include them as an expected part of care."

According to the paper, almost 500,000 Americans die annually from tobacco use, and 16 million have serious tobacco-induced chronic diseases, which results in $170 billion in health care costs. Of the 34 million Americans addicted to nicotine, the authors write, too few receive cessation assistance from health care professionals.

"Including smoking treatment as part of hospital care just makes sense," said Dr. Michael Fiore, director of the University of Wisconsin Center for Tobacco Research and Intervention, and a co-author of the report. "How can a hospital be designated as 'best' if it neglects to help people overcome the biggest risk to their health?"

Given the lethality of tobacco dependence, the authors write that addressing it should be a priority, especially since tobacco use affects all of the health conditions on which hospital rankings are based.

"Our analysis of data from the Joint Commission demonstrates a major missed opportunity for our leading hospitals to focus vigorously on helping their patients who smoke to quit," said Dr. Steven Schroeder, professor of medicine at UC San Francisco and the paper's other co-author. "They could not only improve the health of their patients but also set an example for the rest of the country."

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