Cover Page

St. Francis Medical Center

Vida Sana Quality Interventions to Transition Smokers
Vida Sana QUITS
Proposal to
Smoking Cessation Leadership Center at UCSF and
Pfizer Medical Education Group
October 18, 2012

All required fields completed online

in the Pfizer Grant Management system

Grant ID 044920/St. Francis Medical Center/Vida Sana QUITS

Table of Contents
B.

Table of Contents ..........................................................................................i

C.

Primary Investigator Information ............................................................... 1

D.

Proposal ...................................................................................................... 2
1. Overall Aim and Objectives ..................................................................... 2
2. Current Assessment of Need in Target Area .......................................... 5
3. Technical Approach ................................................................................. 7
4. Evaluation Design .................................................................................. 10

E.

Detailed Workplan .................................................................................... 11

F.

Detailed Budget ........................................................................................ 14

G.

Organizational Detail ................................................................................ 15

I.

Letters of Commitment............................................................................. 17

i.

C. Primary Investigator (PI)

Mary Lynne Knighten, MSN, RN, PN, NEA-BC, DNP(c) has taken a critical leadership role in the
pursuit of a healthy, smoke-free environment in Southeast Los Angeles and at St. Francis
Medical Center. She developed the concept of Vida Sana QUITS and will act as the Primary
Investigator for its duration.
Ms. Knighten is a nurse executive with more than twenty years of progressive management
experience in leading patient care operations, developing staff, hospital and community-based
healthcare programs, developing clinical programs, improving patient satisfaction and quality
outcomes, identifying cost efficiencies, controlling budgets, and ensuring regulatory compliance
for major medical centers and teaching hospitals. An established expert in patient and family
centered care, Ms. Knighten has a demonstrated ability to create a participative management
culture while maintaining strict oversight, keeping managers accountable for delivery of patient
care.
As Senior Director of Patient Experience and Care Delivery at St. Francis Medical Center, Ms.
Knighten is responsible for all aspects of the patient experience and implementation of a
patient and family centered model of care delivery. Currently, Ms. Knighten has administrative
responsibility for the Behavioral Health Service Line, the Skilled Nursing Facility, Palliative Care,
the Education Department, Decedent Affairs and the Advocacy Office. During her tenure at
SFMC, Ms. Knighten improved sepsis mortality by developing leadership skills in direct care
nurses to drive change from the front-line using the improvement model contributing to a
national award from QUEST Premier from improving quality core measures; facilitated
implementation of over 50 PFCC strategies; improved HCAHPS overall rating of hospital 9/10
Top Box score by four percentage points in eighteen months, doubling the national average of 2
percentage points; and, led Behavioral Health Services as the only service line to gain market
share in the past two years.
In 2011, Ms. Knighten was awarded a grant and in-kind support totaling $20,000 from LACDPH
for the L.A. Pioneers smoke-free project. The success of that endeavor was, to large extent, the
impetus for the design of the Vida Sana QUITS project. As PI for the project Ms. Knighten will
manage the resources of the projectincluding staff and financial resourceswill plan and
control the project activities and will oversee all communications with regards to Vida Sana
QUITS. Specifically, Ms. Knighten will supervise the clinician/health educator in developing the
projects infrastructure, monitor healthcare staff to ensure that the project is conducted in
accordance with the terms of the grant agreement, and report project progress toward meeting
the objectives outlined in the grant proposal.
Contact information:
Mary Lynne Knighten, MSN, RN, PN, NEA-BC, DNP(c)
Senior Director, Patient Experience and Care Delivery, St. Francis Medical Center
3630 East Imperial Highway, Lynwood, CA 90262
Phone: (310) 900-8593; Fax: (310) 900-8880
MaryLynneKnighten@dochs.org

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D. Proposal
1. Overall Aim & Objectives:
The overall aim of the Vida Sana QUITS (QUality Interventions to Transition Smokers) Project is
to improve clinical outcomes by training health professionals and community health promoters
how to apply proven smoking cessation strategies in a culturally competent manner utilizing
discipline and population specific curriculum. Involving staff at the hospital and the Vida Sana
InitiativesSFMCs flagship community benefit effortthe project builds on the success of the
Los Angeles (L.A.) County Pioneer Smoking Cessation project (LA Pioneers).
LA Pioneers developed a train-the-trainer smoking cessation curriculum that was shown to be
highly successful in motivating community members to change their attitudes and ultimately
their habits around tobacco use. Vida Sana Initiatives is a multi-faceted effort to improve
community health among low-income, underserved populations through health promotion,
disease prevention, and management of chronic conditions. Vida Sana QUITS will develop a
new curriculum by applying concepts of the Pioneer Project curriculum while providing an
approach that is more tailored toward the specific communities and healthcare disciplines that
will ultimately benefit from the proposed interventions. The new curriculum developed will be
both discipline specificapplicable to health professionals practicing in various professional
healthcare practitionersand population specificaccounting for differences in socioeconomic and cultural factors, educational attainment and health literacy as well as whether
the individual in question is an inpatient or a community member seeking services at a
community based program offered by the hospital. Ultimately Vida Sana QUITS will create a
curriculum that can be effectively utilized by everyone from primary care providers to
community health workers (promotoras) and mental health professionals and that respond to
the specific circumstances of their audience.
The current evidence-based curriculum consists of training around six topic areas including 1)
Healthy Behaviors; 2) The Truth about Tobacco; 3) Changing Behaviors; 4) Coping with Cravings;
5) Managing Stress; and 6) Planning Ahead. Specific didactical information on smoking cessation
is augmented by information on the role of the health worker within the smoking
cessation/motivation process. The new curriculum will include modifications that will allow
health practitioners to customize interaction with their patients so that the message delivered
is appropriate to the socio-economic and cultural circumstances and health literacy level of the
recipient. In addition, the new curriculum will incorporate a comprehensive list of strategies
and will show which strategies and which combination of approaches is most effective with
individuals from specific socio-economic or cultural backgrounds. The curriculum will teach
healthcare providers to employ interview techniques designed to elicit accurate information
about smoking habitsovercoming the stigma that has historically been shown to prevent full
disclosure of tobacco use.
Once completed, the Vida Sana QUITS curriculum will be used to train a core group of St.
Francis Medical Center (SFMC) health professionals engaged in direct patient care either at the
hospital or through Vida Sana Initiatives. Traineesincluding physicians, direct-care nurses,
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parish nurses, promotoras, patient family advisors, respiratory therapists and mental health
professionals (social workers, PET Team members)will then use that training to provide
culturally and linguistically appropriate smoking cessation interventions to people in various
locations including the hospital itself, community centers and churches. The interventions
provided will run the gamut from providing passive education, information and basic messaging
that builds awareness of the dangers of tobacco use to offering more intensive lifestyle
intervention workshops and support groups along with nicotine replacement therapy.
Project goals include the following:
1.

Develop the programmatic and capacity infrastructure of SFMC (including training,

implementation, marketing and evaluation) to provide initial and ongoing training of
healthcare professionals who teach smoking cessation strategies to patients and the
community.

2.

Utilize the evidence-based Train-the-Trainer modules from L.A. Pioneers Smoke-Free

Project to create a new, culturally and linguistically appropriate, discipline and
population specific methodology around smoking cessation intervention.

3.

Train a cadre of health professionals in various disciplines to effectively offer smoking

cessation intervention along a continuum of intensity levelsfrom raising awareness to
providing pharmacological intervention in tandem with behavioral modification
strategies.

4.

Newly trained healthcare workers in community settings will provide community

members with information on tobacco use, introducing smoking cessation strategies
and techniques.

5.

Newly trained healthcare workers in community settings will provide support groups to
provide more substantive support for smokers who have resolved to quit or cut back
and/or for smokers who are in the process of quitting.

6.

Newly trained healthcare workers at the hospital will have a greater range of strategies
at their disposal to address smoking cessation with patients including motivational
interviewing, pharmacological intervention, and the ability to refer to smoking cessation
support activities available through Vida Sana Initiatives.

7.

Develop a refresher/review course for the newly trained healthcare workers designed
specifically for post-grant award continuity.

8.

Evaluate the effectiveness of the infrastructure development, the training activities,

retooling the curriculum, and the effectiveness of the delivery mechanism.

SFMC will achieve these goals by successfully executing the following objectives:

Produce a discipline and population-specific Vida Sana QUITS curriculum for use by
hospital and community-based healthcare personnel associated with St. Francis Medical
Center and Vida Sana Initiatives within six months of funding.

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Provide approximately 80 to 120 health professionals over the grant period including
physicians (approximately 40), direct-care nurses (approximately 40), parish nurses
(approximately 4), respiratory therapists (approximately 7), promotoras (approximately
8), mental health professionals (approximately 20), and patient family advisors
(approximately 5) with training in how to deliver culturally appropriate smoking
cessation strategies as measured by Vida Sana QUITS sign-in sheets and feedback
surveys.

Provide a total of two (2) Continuing Medical Education courses, ten (10) direct
trainings, and four (4) refresher courses using the new Vida Sana QUITS curriculum to
accommodate the schedules and training needs of the healthcare professionals served
through the project.

Provide a minimum of 65 support groups with an average weekly attendance of 5 to 10

individuals as evidenced by sign in sheets and feedback/survey forms collected.

Provide smoking cessation messaging reaching approximately 2,000 community

members over the grant period via healthcare personnel engaged in Vida Sana
Initiatives community health promotion programs and mobile health van as evidenced
by participant tracking sheets and class rosters.

Provide a minimum of 1,000 hospital in-patients with interventions and/or smoking

cessation messages and support at the hospital by healthcare personnel trained through
Vida Sana QUITS as evidenced by self-reporting by healthcare professionals.

The impact of this project on the community served will be as follows:

1) The community will benefit from consistent and culturally appropriate messaging on
tobacco use and smoking cessation methods available that are delivered through several
health and wellness initiatives available through the hospital;
2) A measurable increase in self-reported smoking cessation based on SFMCs proven track
record in various health promotion initiatives of delivering culturally and linguistically
appropriate interventions;
3) A greater awareness among healthcare professionals, across disciplines, of proven
methodologies to help patients and community members in their smoking cessation
strategies; and;
4) Improved accuracy of information gathered by teaching trainees to use motivational
interviewing and the educational teach back method to elicit accurate information from
socio-economically and ethnically diverse clients, creating the reciprocal information
sharing necessary to initiate and maintain a change in behavior.

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2. Current Assessment of Need in Target Area:

Vida Sana QUITS builds on two effortsthe L.A. County Pioneers Smoking Cessation Project
discussed in Section 1 and SFMCs proven, hospital-based, smoking cessation strategies that
reduced smoking rates among participating patientsby adapting components of those
interventions and incorporating motivational interviewing and other strategies to create a
curriculum that can be effectively utilized by various health professionals to respond to the
circumstances and health literacy level of specific audiences. SFMC has a smoking protocol in
place, collects data on smoking at community wellness and health screening events in addition
to hospital admissions, and provides passive smoking cessation education in the form of written
and verbal material. Smoking cessation strategies implemented in SFMCs Outpatient
Psychiatric Services program, for example, resulted in 50% of patients who smoked either
quitting or reducing their nicotine intake.
Baseline Data
Smoking is the leading cause of preventable morbidity and mortality in the United States 1. The
general decline in smoking rates that was observed in the U.S. between 1970 and the year 2000
has stalled. Between 2005 and 2009 the National Health Interview Survey found that smoking
rates across the nation remained constant. Although residents in the Western U.S. smoke at
lower rates than in other areas of the country, numerous and significant risk factors for
smokinglow income, low educational attainment and large numbers of recent immigrants 2
are prevalent in the communities served by SFMC.
The highest cigarette smoking burden in 2009 was on residents living below the federal poverty
level and those whose educational attainment was low 3. In 2009, 20.6% of adults in the U.S.
were current smokers (defined as smoking every day or some days) including nearly 24% of
men and 18% of women 4. People who live in poverty, however, smoke at significantly higher
rates than their more affluent counterparts. Estimates from the 2009 National Health Interview
Survey and the 2009 Behavioral Risk Factor Surveillance System indicate that 31% of adults
living at or below the federal poverty level and 28.5% of adults with less than a high school
diploma were current smokers (compared with just 5.6% of residents with a graduate degree 5).
Finally, recent data show that immigrant populations also experience a higher than average
smoking rate of 21.6%.
Southeast Los Angeles Community Data
Income in SFMCs service area is markedly lower than the national and countywide averages.
Twenty-eight percent of families in Service Planning Area (SPA) 6 and 14% in SPA 7 live at or
below 100% of the Federal Poverty Level and, in the nine communities where most SFMC
patients reside, the poverty rate is significantly higher than the county averages. Fully 24% of
1

Vital Signs: Current Cigarette Smoking Among Adults Aged 18 years [and older]United States 2009. Morbidity and Mortality
Weekly Report. The Centers for Disease Control and Prevention. September 10, 2010 / 59(35);1135-1140
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a3.htm
2
Ibid.
3
Vital Signs: Current Cigarette Smoking Among Adults Aged 18 years [and older]United States 2009. Morbidity and Mortality
Weekly Report. The Centers for Disease Control and Prevention. September 10, 2010 / 59(35);1135-1140
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a3.htm.
4
Ibid.
5
Ibid.

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residents in Lynwood; 28% in Compton, 22% in Paramount, 25% in Huntington Park, 24% in
Cudahy, 24% in Bell, 11% in Downey, 19% in South Gate, 25% in Maywood, and 27% in Bell
Gardens 6 live below the federal poverty level 7. It is important to note that the high cost of living
in Los Angeles County places additional strain on low-income families. According to the Public
Policy Institute of California, when cost of living is factored into the equation, the poverty rate
in Los Angeles County jumps from 15% to 26% 8.
Research, and our own community data, shows that low-income residents of Southeast Los
Angeles tend to have low educational attainmentanother risk factor associated with high
rates of smoking. In Maywood, 42% of residents have less than a 9th grade education, followed
by Bell Gardens 41%, Cudahy 38%, Bell 36.5%, Huntington Park 35%, South Gate 33%, Lynwood
29%, Paramount 26%, Compton 24.5%, and Downey 12.5%. Our communities have a high
concentration of households where Spanish is the primary language. In Huntington Park,
Spanish is the primary language in 93% of households followed by 92% of households in Bell
Gardens, 91% in Maywood, 90% in Cudahy, 87% in South Gate, 86% in Bell, 79% in Lynwood,
71% in Paramount, 59% in Compton and 58% in Downey.
Arguably the most important social determinant of health status other than poverty is
insurance status. Los Angeles County had the largest number of uninsured residents in the state
with 2.7 million children and adultsfully 28.9% of the population experiencing some period of
being uninsured in 2009. 9 The Kaiser Commission on Medicaid and the Uninsured found that
individuals living below the poverty level are at the highest risk of being uninsured and
comprise more than 40% of the uninsured. 10 Uninsured and underserved populations also
utilize emergency health services for non-emergency conditions at a higher rate than their
insured counterparts and experience a greater degree of difficulty in accessing preventative
careresulting in barriers that prevent these populations from having access to the latest
information and advice from health professionals. The Vida Sana QUITS program addresses this
by bringing smoking cessation messages into the community.
SFMC Patient & Community Program Participant Data
In 2010, only 5% of the 20,313 patients admitted to SFMC acknowledged that they were
current smokers on their admission forms. In 2011, the My Life Check questionnaire
administered to participants in our community-based Vida Sana program revealed that 6% of
participants reported being current smokers and an additional 5% reported having quit smoking
greater than 12 months prior. Given the prevalence of smoking among poor, uneducated and
immigrant populations, and given the large concentration of such residents in SFMCs service

U.S. Census Bureau State and County Quickfacts. Retrieved online at:
http://quickfacts.census.gov/qfd/states/06/0646492.html.
7
U.S. Census Bureau State and County Quickfacts. Retrieved online at:
http://quickfacts.census.gov/qfd/states/06/0646492.html.
8
PPIC calculations using U.S. Census Bureau, Current Population Survey, Annual Demographics Files for trends, and American
Community Survey (2006) for racial/ethnic, child, county, and working-poor statistics.
9
St. Francis Medical Center. Building Healthier Communities: Community Benefit Programs FY 2010 Update. St. Francis Medical
Center, Lynwood, CA. page 14.
10
Five Facts About the Uninsured. Kaiser Commission on Medicaid and the Uninsured. September 2010. Retrieved online at:
http://www.kff.org/uninsured/upload/7806-03.pdf.

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area; SFMC is confident in asserting that the smoking rate is likely much higher than reported
by the target population.
In addition to data provided through questionnaires and hospital admission forms, SFMC has
assessed the current need for smoking cessation interventions by conducting a review of
published literature, consulting the Community Needs Assessment conducted by the hospital
each year, and by reviewing feedback from front-line personnel including community health
workers engaged in health promotion activities at SFMC. According to a recent report entitled
Cigarette Smoking in Los Angeles County: Local Data to Inform Tobacco Policy (June 2010)
produced by the Office of Health Assessment and Epidemiology at the County of Los Angeles
Public Health Department, nearly 115,000 smokers reside in Southeast Los Angeles. SFMCs
2010 Community Needs Assessment showed that 19.7% of residents in the primary service area
(SPA 6) were smokersa far greater number than in any other SPA in L.A. County. Given the
risk factors for smoking in the service area, the logical assumption would be that SFMC patients
would smoke at rates that far surpass the rates reported. Yet epidemiological data analysis of
patient information gathered on admissions, and interviews with community-based and direct
care staff indicates that there is significant underreporting of smoking prevalence among SFMC
patients.
The prevalence of underreporting cigarette smoking in our communitiesprincipally immigrant
or ethnic minority populationsspeaks to the stigma associated with smoking in these
communities. The stigma and a reluctance to give answers that the patient believes the
interviewer does not want to hear, makes the delivery of smoking-cessation strategies more
challenging. In addition, many individuals deny the smoking label, even though they may
infrequently use cigarettes at social events, while consuming alcohol, or other specific times.
Many liquor stores sell single cigarettes for those occasional smokers. The use of motivational
interviewing by all healthcare disciplines will delve into this often-forgotten area of tobacco
use. Training healthcare professionals to apply smoking cessation strategies that will overcome
the stigma and other barriers to eliciting accurate feedback addresses a clear gap in practice at
SFMC and in the Vida Sana program.
3. Technical Approach, Intervention Design and Methods:
Development of Infrastructure
Vida Sana QUITS will enable SFMC to build its capacity to provide smoking cessation strategies
by amassing a comprehensive listing of area resources, training healthcare workers, and
creating smoking cessation materials that are appropriate for all disciplines and
populations/audiences. This project will also build capacity by addressing the lack of
appropriate, relevant training of healthcare professionals that has resulted in significant
underreporting of tobacco usage in underserved community. At the core of a successful
implementation of Vida Sana QUITS is the development of a population and discipline specific
smoking cessation curriculum. The project infrastructure and curriculum development will be
spearheaded by the Program Manager. The implementation methods that will be used will
include didactic instructional techniques delivered in a hospital setting; community based
intervention delivered by community health workers in trusted community sites; and hospital
based interventions delivered at SFMCs main facility.
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Didactic Instructional Techniques (or Training the Trainers):

Vida Sana QUITS will combine cultural and linguistically appropriate motivational interviewing
with the modules and implementation package obtained during the L.A. Pioneers outreach
associated with Project TRUST (Tobacco Reduction Using Effective Strategies and Teamwork).
The goal of Project TRUST is to reduce tobacco use in high-risk communities across the country
through policy, systems and environmental change interventions. The goal of motivational
interviewing is to elicit and strengthen motivation for change through a patient/personcentered approach.
Motivational interviewing focuses on exploring and resolving ambivalence about change by
centering on the individuals capacity to alter patterns of destructive or addictive behavior. The
technique affirms the values, outlook and cultural norms of the person being interviewed and
uses that as the basis for strengthening the persons willingness and motivation to modify
behavior. Vida Sana QUITS will teach motivational interviewing in conjunction with the trainthe-trainer Project TRUST curriculum to both hospital staff and community health workers. This
technique will open the door for other strategies and interventionsfrom pharmacological
intervention to support groups and educational classesto be presented by the healthcare
workers and hopefully adopted by the recipient.
Community-Based Intervention:
SFMC firmly believes that reaching our communities with health information, especially
preventative, is key to promoting life-long wellness and disease prevention. SFMC administers
several successful, community programs that utilize promotoras and Parish Nurses as
community-based health educators, to influence life-style behaviors and reduce physical and
behavioral risk factors for disease. Studies show that the use of community health educators
can be highly effective in low-income, ethnically diverse populations. One policy paper
commissioned by The California Endowment in 2008 found that Because of the relationship
they [promotoras] have with their community, they are particularly effective at reaching Latinos
and other unserved and underserved families and individuals. They can help address multiple
barriers to accessing services, such as those related to transportation, availability, culture,
language, stigma, and mistrust 11. Results of the Move More initiative in the Vida Sana
program, an exercise component, are measured with the aid of a custom built database for
designed for statistical analysis. Outcome data showed 35% of the adults improved their
physical activity 3 to 5 days per week following health promotion intervention and 18% of
children improved their physical activity 3 to 5 days per week following health promotion
intervention. Results of the Eat Smart intervention, focused on healthy food choices,
demonstrated that 67% of adults and 78% of children increased their consumption
4of
servings of fruits and vegetables per day following nutritional education and personal health
counseling. Often times, community members regard the promotoras and parish nurses as
medical authorities since they have little contact with physicians other than through a hospital
11

Rhett-Mariscal, PhD. Promotores in Mental Health in California and the Prevention and Early Intervention Component of the
MHSA. Funded by The California Endowment and prepared by the Center for Multicultural Development at the California
Institute for Mental Health, November 2008. Retrieved 10/12/12 at:
http://www.cimh.org/LinkClick.aspx?fileticket=Qw5mqcEahTI%3D&tabid=568

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admission. These programs are clearly effective in changing perception and behavior among the
target population and SFMC is confident that the strategy will prove equally as effective in
reducing smoking.
Community Health Workers: Promotoras and parish nurses work in the community and
therefore have different opportunities to address smoking. Motivational interviewing is an
excellent fit with SFMCs utilization of community-based health professionals and community
health promoters (promotoras). Engaging community members in health promotion is a
strategy that has proven to be exceptionally effective in reaching underserved and diverse
ethnic groups. These personnel are able to quickly establish rapport with clients, building on a
previously established sense of trust. These relationships are often the key to the success of
smoking cessation efforts, particularly in underserved communities like SPA 6 where SFMC is
located. Training these professionals to address smoking cessation through motivational
interviewing, education, anti-smoking messaging and support groups gives them a broad array
of tools with which to empower and inform residents, creating a greater aptitude for medical
consumerism around smoking cessation.
Interventions provided by community health workers will include individual outreach touches,
support groups, educational classes that include messages on smoking cessation and carbon
monoxide monitoring, and outreach touches provided through the mobile health unit.
Hospital-Based Intervention:
Smoking cessation training for physicians, direct-care nurses and patient family advisors
respiratory therapists and mental health professionals (social workers, PET Team members) at
the hospital will focus on how to use motivational interviewing to initiate conversations about
smoking that will elicit honest information and set the stage for change. Staff will be trained on
various pharmacological interventions that have been shown to increase the efficacy of
smoking cessation strategies including the Nicotine Replacement protocol that is already in
place at SFMC. Patients will receive multiple touches at the hospital, from staff at various
levels and in different specialty areascreating an atmosphere that de-stigmatizes smoking in
an effort to motivate behavioral changes. Hospital patients will have access to pharmacological
intervention, information and referrals to the community based smoking cessation efforts
available through Vida Sana QUITS including support groups and educational classes. Vida Sana
QUITS will establish sufficient skill levels in healthcare professionals across several disciplines to
enable them to provide culturally competent smoking cessation interventions to individuals and
groups.
A crucial component to sustaining the projects momentum over the long term is development
of follow-up training sessions to reinforce the principles and methods taught during the initial
grant period. These refresher courses will be provided on a quarterly basis after the grant
period. Since the lions share of the funding request will be used for infrastructure
development, we anticipate that the infrastructure growth will be sufficient to fully integrate
the training into the routine training of healthcare workers at SFMC (Physician committees,
Department Meetings, community program meetings, etc.) which will provide longevity for the
activities without requiring significant additional financial resources.

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4. Evaluation Design:
Smoking rates, understanding of the consequences of smoking, number of cigarettes typically
smoked, interest in quitting and other specifics will be measured via pre- and post-test survey
instrument for hospital patients and community members. Individuals involved in more
intensive support and intervention will have their self-reporting of cessation successes
confirmed through monitoring individual carbon-monoxide levels at the Vida Sana QUITS
support meetings. Participants will be queried one month post-intervention and again at six
months to measure sustainability of smoking cessation strategies. Patient Activation Measures
surveys for monitoring smoking cessation will be created from our custom built National Health
Foundation software and administered to participants.
The efficacy of the training itself will be measured via pre- and post-training surveys that will
gauge health personnel knowledge and attitudes as well as willingness to adopt the new
strategies. Surveys will also seek to measure engagement (e.g. determine their most recent
efforts to discourage smoking, and how they engaged the patient or community member).
Changes in behaviors will be tracked over the course of the project using follow-up surveys as
well as feedback collected at refresher courses. Data collected from Vida Sana QUITS will be
evaluated by the Principal Investigator with the assistance of an outside evaluator such as
Clinical Care Extenders from COPE Health Solutions or National Health Foundation. Because of
the projects reliance on an outside evaluator, the evaluation process is not fully developed.
However, it is anticipated that at a minimum the program evaluation will show the following
outcomes:

An estimated 25% of participants who participate in intensive smoking cessation

intervention strategies including motivational interviewing, pharmacological
interventions, and weekly educational classes or support groups will have quit smoking
or reduced nicotine intake as demonstrated by surveys collected and by carbon
monoxide monitoring conducted at weekly classes/groups.

An estimated 75% of healthcare personnel trained will report an improved confidence in

their ability to effectively deliver proven educational interventions on smoking cessation
as demonstrated by pre- and post- training surveys.

An estimated 75% of healthcare professionals will report increases in the number of

messages delivered by healthcare professionals when compared to control group
results.

Community members and patients participating in ongoing activities will be asked to complete
a brief survey each time they access information or services. The survey will include:

Number of cigarettes used daily;

Carbon monoxide level measured;

Medications used;

Whether the participant has quit smoking or has a quit date in mind;

Whether the participant has cut down on smoking; and

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What particular strategy they find to be most helpful.

The Program Manager will work with hospital staff to recruit a control group of healthcare
professionals who have not received the training to act as a control group. This group will be
queried on a quarterly basis to determine how many patients self-report tobacco use to the
non-trained healthcare personnel, how many smoking cessation messages are delivered, and
how many smoking cessation interventions (pharmacological or referrals to support groups) are
provided. This control group will commit to providing quarterly updates on smoking cessation
intervention and messaging activities for a one year period.
Because SFMC has a smoking cessation protocol already in place, we anticipate a high rate of
target audience engagement and follow through. Because the overall number of healthcare
professionals trained is relatively small within each discipline, we anticipate that the providers
who volunteer to undergo the training will be those who experience significant self-motivation
to follow through on the opportunities presented by the training.
Once the infrastructure is developed for ongoing training of healthcare professionals, it will be
quite simple to use a plug and play approach with any future healthcare professionals.
Smoking cessation techniques will be incorporated into other health promotion activities within
the Vida Sana Initiatives, making the delivery of services part of their ongoing program.
Additionally, there may be an opportunity to bill Medicare for beneficiaries who attend
outpatient smoking cessations groups.
This project is an excellent candidate for dissemination. The Train-the-Trainer curriculum
already exists, and SFMC is well versed in evaluating program results and creating report
documents. SFMC will make a full accounting of the project to the grantor, the steps taken,
challenges encountered, and overall success available to other hospitals within the Daughters
of Charity System, Ascension Health System, and via partnership with L.A. County Pioneers
agencies, ACNL, Hospital Association of Southern California and other key stakeholders.

E. Detailed Work Plan and Deliverables Schedule:

Please see attached work plan.

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St. Francis Medical Center

Vida Sana QUITS Work Plan
Goal/Dollar
Amount
Infrastructure
Build / $39,500

Training /
$12,000

Implementation
/ $15,000

Key Activities and Deliverables

1. Project is funded.
2. Primary Investigator will schedule an initial team meeting with the Program Manager, the
Director of Vida Sana and other personnel to outline action plan activities, grant objectives and
reporting requirements.
3. Initiate curriculum modification to include discipline and population specific training modules and
create materials that are appropriate for all disciplines and populations/audiencescreating a
tailored Vida Sana QUITS curriculum.
4. Incorporate Motivational Interviewing (MI) into the curriculum to help strengthen motivation for
change in the target population.
5. Determine how to address the cultural and other barriers that contribute to significant
underreporting in underserved communities and incorporate strategies to address the issue.
6. Develop a refresher/review course for the newly trained healthcare workers designed to provide
follow-up support and additional learning.
7. Create a comprehensive guide to area resources for smoking cessation and create bilingual and
online editions of the guide.
8. Create evaluation/feedback surveys for dissemination to trainees and community members to
collect baseline data for future evaluation.
9. Provide Project TRUST and Motivational Interviewing techniques as part of the Vida Sana QUITS
curriculum to all program staff in preparation for training healthcare personnel.
1. Recruit healthcare personnel including physicians, direct-care nurses, parish nurses, promotoras,
patient family advisors, respiratory therapists and mental health professionals (social workers,
PET Team members to participate in the training.
2. Schedule and conduct ten (10) training sessions for 80 to 120 healthcare personnel over the
grant period and collect evaluation and feedback data.
1. Trained personnel will use MI techniques outlined in the training to elicit accurate information
about smoking activities from community members.
2. Personnel will use discipline and demographic specific interventions to address tobacco use

Grant ID 044920/St. Francis Medical Center/Vida Sana QUITS

Time Frame
December
2012 May
2013

April 2013
May 2013

June 2013
December
2014
Page 12

Goal/Dollar
Amount

Evaluation /
$7,060

Identify
Dissemination
Strategies /
$1,500
Final Grant
Progress Report
/ $500

Key Activities and Deliverables

among hospital patients and community members by offering pharmacological intervention,
education, information, and referrals to classes and support groups.
3. Provide a minimum of 65 support group/smoking cessation classes with an average attendance
of 5 to 10 individuals.
4. Provide 2,000 community members with smoking cessation messaging and information offered
in community sites and through the Vida Sana mobile health van in Southeast Los Angeles.
5. Healthcare personnel trained through Vida Sana QUITS will provide a minimum of 1,000 hospital
inpatients with educational information and/or smoking cessation messages at the hospital.
1. Evaluate the effectiveness of the infrastructure development process by conducting a 360 degree
type of review processes for personnel, collecting feedback from attendees in the trainings, and
the completion of key deliverables including the discipline and demographic specific Vida Sana
QUITS curriculum, the comprehensive resource guide, the refresher/review curriculum, and
feedback collection and service tracking instruments.
2. Track number of healthcare professionals participating in the training classes and use their
feedback and pre-and post-test surveys to assess the effectiveness of the curriculum and areas
for improvement.
3. Track number of classes and/or support groups provided to the community and how many
participants attend; use feedback from participants to assess the effectiveness of the curriculum
and areas for improvementparticularly in terms of improvements in the accuracy of reporting
of smoking activity.
4. Track the number of community members receiving smoking cessation interventions, the type
and intensity of the intervention utilized and the effectiveness of each based on pre-and posttest survey instruments and monitoring individual carbon-monoxide levels.
1. The Principal Investigator and Program Manager will identify appropriate avenues and timeframe
for the dissemination of the lessons learned in the proposed program to various entities possibly
including (but not limited to) hospitals within the Daughters of Charity System, Ascension Health
System, and via partnership with L.A. County Pioneers agencies, ACNL, Hospital Association of
Southern California and other key stakeholders.
2. Using data amassed through the evaluation procedures, create a final grant report outlining the
project methods, success, challenges and outcomes.

Grant ID 044920/St. Francis Medical Center/Vida Sana QUITS

Time Frame

September
2013
December
2014

January 2014
December
2014

December
2014

Page 13

F. Detailed Budget:
St. Francis Medical Center requests a total award of $76,560 for the Vida Sana QUITS project to
be expended as follows:
$8,000

Program Director/Principal Investigator

This stipend will cover a portion of the time and expertise committed to the Vida Sana QUITS
project by Principal Investigator Mary Lynne Knighten.
$39,500

Program Manager/Clinician/Health educator

This line item will provide funding to support the staff costs associated with building SFMCs
infrastructure and training capacity. These costs include salary for the program manager
position and for a Clinician/Health Educator in addition to ancillary costs associated with
creating a new curriculum and a refresher curriculum.
$12,000

Classes

This line item covers all costs associated with classes provided to healthcare professionals and
to the community including curriculum reproduction, materials, refreshments, stipends for
promotoras and various incidental expenses.
$2,000

Promotional materials

This includes materials associated with community-based classes, support groups, outreach and
various survey instruments.
$2,000

Physician Education

This covers costs associated with the CME specifically for physicians.
$3,500

Database Functionality

This line item will enable SFMC to upgrade its current VSI tracking database to accommodate
the new patient population to be measuredproviding immeasurable benefit in terms of
tracking and evaluation.
$2,500

Incentives to encourage smokers to quit.

SFMCs experience in providing community programs shows that the socio-economic status of
the population served makes incentives an effective method of motivating a change in behavior
and encourages participants to show up for the intervention.
$7,060

Evaluation

Approximately 10% of the total budget cost has been budgeted for evaluation.
$76,560

Total

Grant ID 044920/St. Francis Medical Center/Vida Sana QUITS

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G. Organizational Detail:
1. Leadership and Organizational Capability:
Established in 1945, St. Francis Medical Center (SFMC) is one of the largest private
Disproportionate Share Hospitals in the nation and the only comprehensive, non-profit health
care institution serving Southeast Los Angeles. Located in Lynwood, SFMC is one of six hospitals
that make up the Daughters of Charity Health System (DOCHS) in Californiaa regional
healthcare system of hospitals and care centers spanning the California coast from the Bay Area
to Los Angeles. DOCHS sponsors are the Daughters of Charity of St Vincent de Paul who, for
more than 370 years, have been serving the sick and the poor through healing ministries
around the world.
SFMCs Mission reflects the Daughters guiding principleto serve the sick and the poor. No ill
or injured man, woman, or child is ever turned away because of the inability to pay for needed
care. The Vision of the organization is to be a values-driven, integrated healthcare delivery
system that promotes the development of the human person, the preservation of health, and
the well-being of the community.
St. Francis Medical Center provides a full range of diagnostic and treatment services, operating
a 384-bed acute care hospital; four community-based health clinics; the largest and busiest
private emergency trauma center in Los Angeles County; a Family Life Center and state-of-theart Neonatal Intensive Care Center; Centers of Excellence in Heart and Vascular Medicine and
Obstetrics; and a growing school-linked health program.
SFMCs wide-array of services include:
Behavioral Health Services
Bioethics Program
Childrens Counseling Center
Community Clinics
Emergency & Trauma Services
Heart and Vascular Center
Health & Workplace Safety
Imaging Services
Industrial & Occupational Medicine

Intensive Care/Critical Care Unit

Outreach Programs
Pastoral and Spiritual Care Services
Radiation Oncology
Rehabilitation Services
Skilled Nursing Facility
Sweet Beginnings in Our Family Life Center
Wound Care Center

Meeting the health needs of the one million Southeast Los Angeles residents who reside in
SFMCs service area requires a multi-pronged approach to service provision. In addition to direct
medical care, SFMC provides a broad array of community service programs that represent a
continuum of care for disenfranchised populations. The hospitals philanthropic endeavors focus
on nurturing healthy children and families, building self-sufficiency, and achieving excellence
for facilities and technology with the ultimate goal of enhancing the health of our community.
To this end, the organization operates the Health Benefits Resource Center (HBRC), the St.
Francis Career College (SFCC), community health fairs and screenings, Childrens Counseling
Center, and programs for seniors and homeless families.
All of SFMCs programs exist to meet the needs of low-income and underserved community
members and are created in collaboration with myriad community organizations and
Grant ID 044920/St. Francis Medical Center/Vida Sana QUITS

Page 15

stakeholderspartnerships that allow the hospital to reach people in the places where they
live, work and play.
2. Staff Capacity:
If SFMC is awarded the opportunity to implement Vida Sana QUITS, Outpatient Psychiatric
Services Manager Ms. Catherine Wulfensmith will act as Program Manager. She will oversee all
aspects of infrastructure development and, under the guidance of the Principal Investigator,
will create the new curriculum, guide and materials, and smoothly integrate Vida Sana QUITS
into the context of the hospitals behavioral modification efforts as a whole. Ms. Wulfensmith
has a keen understanding and awareness of the importance of incorporating SFMCs Mission
serving the sick and the poorinto all areas of service and will develop this program with an
eye for furthering the Mission.
Ms. Wulfensmith is highly committed to managing Vida Sana QUITS and has a proven track
record of successfully implementing new programs, providing education and training to
professionals in various disciplines, and creating messaging specific to the health literacy level
of the community served. Ms. Wulfensmith has designed and implemented population specific
programs at hospitals throughout Los Angeles County, has extensive experience in training,
managing and supervising employees, and has implemented several successful programs from
initial concept to fruition. In particular, Ms. Wulfensmith successfully launched a project that
resulted in a significant reduction of smoking among patients recovering from mental illness
and/or addiction; patients who, on average, have significantly higher smoking rates than any
other segment of the population.
3. Biographical Sketches of Key Project Staff Members:
Ms. Catherine Wulfensmith, a licensed Marriage and Family Therapist and health educator who
successfully implemented a smoking cessation program for SFMCs mental health patients, will
act as the Program Manager for this effort. Ms. Wulfensmith received a B.A. in Psychology from
Nyack College and her Master of Arts in Marriage and Family Therapy from Azusa Pacific
University. In her tenure as the Outpatient Psychiatric Services Manager at SFMC, Ms.
Wulfensmith has rewritten and organized all departmental policies and procedures, developed
educational and guidance materials, started a womens process group and implemented
policies to facilitate patient growth. Her professional presentations include Structured smoking
cessation groups for patients in the Outpatient Psychiatric Services unit, Introversion vs.
Isolation in Recovery, and many others.
Ms. Pamela Carmona, the Healthy Communities Initiative (HCI) health educator, will provide
support and additional culturally competent training for the project. She holds a California State
Teaching Credential, a Master of Public Health and has been in health education for over 15
years. Ms. Carmona is CPR certified, knows the community well and is committed to delivering
health and social services to disenfranchised populations in SFMCs service area.

Grant ID 044920/St. Francis Medical Center/Vida Sana QUITS

Page 16

I. Letter(s) of Commitment:
Please see attached letters of commitment.

J. Submission: Proposal submitted online via the Pfizer Medical Education Group website:
www.pfizermededgrants.com.

Grant ID 044920/St. Francis Medical Center/Vida Sana QUITS

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