ASHLine Annual Report

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Fiscal Year 2013

(July 2012 through June 2013)

Improving the health of Arizonans
through technology based interventions.

Highlights to this report include:
•
•
•

Program Measures
Enrollment Pilot Project
Evaluation in Action

The Arizona Smokers’ Helpline

Page 1 of 8

Summary of the Fiscal Year
Fiscal year 2013 was another strong year for
ASHLine.

self-help information. The proactive referral

year the Evaluation Team used ASHLine data
collected at intake and during coaching calls to
make programmatic changes to improve service
delivery.

ASHLine Core Measures
FY 2012

FY 2013

Incoming Calls

27,606

26,469

# Referrals

12,550

10,518

# Enrolled

11,394

14,214

# Info Only

4,673

3,157

41,630
33%

40,662
30%

# Coaching Sessions
Quit Rate

Community Development Team
•

•

Emphasized the development of sustainable
referral systems by working with organizations
serving a disproportionately high percentage of
tobacco users
Partnered with the Arizona Department of
Health Services Bureau of Tobacco and Chronic
Disease to provide training and ongoing technical
assistance to Community Engagement Staff
within county health departments to expand
their skill set in referral development

Number of Referrals
14,000
12,000
10,000

12,550
10,518

8,000
6,000

4,000
Fiscal year 2013 marked the transition of the
2,000
Referral Development Team into the Community
Development Team.
0
emphasis from working with healthcare providers
FY 2012
FY 2013
industry-wide to develop sustainable referral
systems. Our more strategic focus is now on
partnering with organizations serving a disproportionately high percentage of tobacco users to promote tobacco-

assessment and intervention are provided to all tobacco users served.

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In order to ensure that referral partners
continue to receive quality support outside
Community Development Team partnered with
the Bureau of Tobacco and Chronic Disease to
provide standard and customized training and
ongoing technical assistance to Community
Engagement Staff within county medical and
behavioral health organizations to expand their

Page 2 of 8

Community Development and Referral Call Teams
FY 2012

FY 2013

# Referrals

12,550

10,793

% Reached

55%

53%

% Reached who Enrolled

46%

56%

784

715

1,704

1,269

# Unique Locations
# Unique Agents

Community Development Team provided two
Development Team initiated the planning process for the next Community Engagement Staff summit to be held

insurance companies.

Number of Referrals by Location Type
(Total Referrals = 10,518)
Hospital, Acute Care

2,317

Medical Practice

1,884

Behavioral Health

1,820

Community Health Center

1,614

Community Group

844

County Health Department

600

WIC

409

Well-Woman Health Check

304

Health Insurance Group

199

Dental Practice

150

IHS/Tribal 638

101
-

500

1,000

1,500

2,000

2,500

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Page 3 of 8

Referral Call Team
•

Reasons Referrals were not Reached

referrals
•
receipt of the referral
While the Community Development Team
ensures strong connections between
ASHLine, Arizona health providers, and
other community organizations which
refer clients to ASHLine for services, it is
the Referral Call Team that does the work
of contacting potential clients, informing
them of ASHLine services, and enrolling
them in the program.
Referral Call Team has processed more than

Left a Message Machine
55.4%

Hung Up/
Disconnected
2.5%

Busy
1.4%
Wrong
Number
6.9%
Unable to Talk
Right Now
8.1%

Phone Not in
Service
6.1%

No Contact
Information
0.1%

Left a Message Person
7.3%
No Answer/No
Machine
12.3%

hours.
The Referral Call Team was also heavily involved with quality improvement efforts to increase enrollment of
the time of the call. Different engagement strategies were developed to respond to these different reasons that
clients are not able to complete an enrollment form during a call.

Clients who are referred to ASHLine
services are more likely to use a
prescription tobacco cessation
medication than other clients.

The Arizona Smokers’ Helpline
Coaching Team
•

Delivery of two major clinical training initiatives:
intensive

and

a

one-week

Motivational

Quit Rates
40%
35%

clinical skills in clinical frameworks

38%

30%

•

30%

25%

services; 89% of clients reported their coaching
experience was helpful

20%
15%
10%

The core of ASHLine services are provided by
the Coaching Team. This group of individuals is
answers incoming calls and enrolls clients into

5%
0%
Clients Reach 30 Days
Quit While in Program

7 Month Quit Rate

calls during working hours during this past year.

These involved a combination of lecture and individual staff action plans which were based on call monitoring
which occurred over a three month period and included feedback to the coaches.
A major challenge facing the
coaching team was maintaining
clinical outcomes and customer
satisfaction in the face of sharply
increased caseloads concurrent with
the combined federal and state media
campaigns. Caseloads increased
calls per week per coach at the end
Despite

the

challenges

of

Coaching
FY 2012

FY 2013

11,381

14,300

88%

82%

Avg # Coaching Sessions/Exited Episode

4.2

3.9

Avg # Coaching Sessions for Quit Clients

8.5

7.8

Avg Call Duration for Quit Clients (in mins)

10.6

9.6

% Using Meds

46%

52%

30-Days Quit

32%

38%

New Episodes
% Receiving 1+ Coaching Calls

an

responded “agree” or “strongly agree” to the statement

The Arizona Smokers’ Helpline
Quit Rate by Average Length of
Coaching Calls

7-month point prevalence quit rate dropped
40%

34%

were quit at their 7-months post enrollment
follow-up.
We have found that the average length of
a client’s coaching calls is related to their
7-month quit rate. Calls that are too short
probably do not provide enough support
while those that are too long may not be

30%

37% 37%

29%

37% 36%

34%

33%

29%

20%

10%

have the highest quit rates.
Recent research has shown that harm

0%
1-3

3-5

5-7

7-9

9-11 11-13 13-15 15-17 17+

helping users extend their lifespan. ASHLine works with clients with the goal of achieving complete abstinence
ASHLine coaches were able to help clients reduce their reliance on tobacco as demonstrated by a decrease in
number of cigarettes smoked among clients dropping out of the program.
Clients who exited services while still smoking reported a decrease of
the number of cigarettes they reported smoking daily at intake.
This was a large drop compared to a 28% drop in similar clients
by reducing the number of cigarettes they use on a daily
basis they increase their chances of achieving complete
abstinence on their next quit attempt.

Clients who are quit when they exit
services are highly likely to feel that
they worked well with their coach.

The Arizona Smokers’ Helpline

Page 6 of 8

Enrollment Pilot Project
•
•

The pilot project lead to changes in the internal structure of ASHLine which were aimed at maximizing the

Previous evaluation projects have shown that the
lengthy enrollment process was not viewed favorably
by clients, especially since many of the questions on
the enrollment survey were reviewed with the client’s
The Enrollment Pilot
coaching call. This shortened intake form was piloted beginning in late December when ASHLine experienced

Callback Team
•
•

Increased the proportion of clients reenrolling in coaching services
Implemented an improved version of
the Client Satisfaction Survey that was

Callback Re-Enrollment Rate
8.0%
7.0%
6.8%

6.0%
The Callback Team is largely responsible
for collecting the data ASHLine uses to
monitor its outcomes and program success.
Although the primary focus of the Callback
Team continues to be the administration of the

5.0%

successfully implemented that allows the team
to assist the Coaching and Referral Call Teams
with enrollment during media spikes and other
times of high call volume. The Callback Team
began working with other ASHLine teams
to expand their job knowledge and enhance

1.0%

4.0%

4.9%

3.0%
2.0%
0.0%
Full CIF

Shortened CIF

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Page 7 of 8

and job development. Accomplishments include an increase in the proportion of clients re-enrolling during
and manner in which the 13-month callback list is constructed.
include the evaluation of the accuracy and manner in which the 13-month callback list is constructed. The
Callback Team also substantially increased the proportion of clients who re-enrolled in the program after talking
to a staff member during the callback survey. This increase in re-enrollments is attributed to the shortened version
client to complete the re-enrollment process.

Evaluation Team
•

•

(such as clients with AHCCCS) and developed
methods to tailor coaching services to enhance
their program success
Led the development of ASHLine’s new diabetes
protocol for lifestyle coaching to be implemented

Fiscal Year 2013 was especially busy for the
Evaluation Team. A new approach was formulated
to focus on methods to identify clients at high risk for treatment failure and tailor coaching services to enhance
ASHLine can tailor its services to reduce the disproportionate rate at which this population drops out of coaching
services.
This team also led the development of ASHLine’s new diabetes protocol for lifestyle coaching to be implemented
management into ASHLine’s standard services.
Also important for the Evaluation Team is data
management. New processes were developed to
monitor the databases and a correction project
was initiated to identify and resolve any potential
database issues. This new protocol greatly enhances
the quality of all ASHLine data and analyses based
collected by RTI were integrated into ASHLine’s
database to ensure data are complete.

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enabled the team to diversify its activities
to include collecting qualitative data
through focus groups and one-on-one
ASHLine submitted a paper focused on
referrals by location types for a peerreviewed publication. Also submitted
was a CDC registry development grant.
Accomplishments include receipt of
pharmacist led medication management
program at ASHLine.
Evaluation Team is to keep ASHLine’s
state and county partners apprised of
ASHLine’s performance on a monthly

Page 8 of 8

Number of Coaching Calls
and Quit Rate
35.0%
30.0%

33.1%

25.0%
20.0%

22.6%

15.0%
10.0%
5.0%
0.0%
1+ coaching calls

0 coaching calls

Evaluation Team routinely provides reports including monthly reports to the county partners about referrals and
and quarterly state performance reports.
ASHLine training have been produced. Other activities the Evaluation Team participated in were the North
a comprehensive evaluation of ASHLine’s external relationships. The Evaluation Team Manager also acted as
Preceptor for a University of Arizona College of Public Health internship.

found that program engagement is a key to success. The seven month quit rate for clients who take at least
one coaching call after enrollment is substantially higher (33.1%) than clients who never take a call after they
who never take a coaching call. Understanding that engaging clients with coaching during the initial enrollment
Enrollment Team and is available to provide preliminary
coaching to clients during the enrollment call. This
service provides clients with the opportunity to speak
with a trained staff member in detail about quitting
tobacco (which hopefully engages them further) before
having to wait to be formally assigned to an ASHLine
coach.

Arizona Smokers’ Helpline

Phone: (800) 556-6222
info@ashline.org