# ASSIST: Assessment of Medicaid policy on Smoking Cessation Assistance and Surgical Outcomes

> **NIH NIH R01** · OREGON HEALTH & SCIENCE UNIVERSITY · 2024 · $610,088

## Abstract

PROJECT SUMMARY
Smoking is associated with a variety of adverse health effects, including increased postoperative wound
healing time, wound infections, and cardiovascular complications among surgery patients. The associations
between pre-operative smoking cessation and improved surgical outcomes have led surgeons and hospitals to
implement policies that require patients to quit smoking prior to elective surgeries. Given the high rate of
smoking among socioeconomically disadvantaged populations and the even higher rate among Medicaid-
insured surgery patients, these policies will disproportionately impact patients of lower socioeconomic status
(SES). In 2017, Oregon implemented the first statewide policy in the United States that requires Medicaid-
insured patients to quit smoking prior to a broad range of elective surgeries as a condition of payment for
surgery by the state Medicaid program. This policy creates an opportune time to assist patients in quitting
smoking pre-surgery (i.e., a “teachable moment”) and to support continued abstinence during post-operative
visits; thus, this policy could result in higher rates of cessation assistance and cessation among patients of
lower SES, potentially mitigating long-standing smoking-related disparities and providing support for
implementation of similar policies among payers and health care systems. That said, some suggest that if
patients do not receive cessation assistance and are denied surgery because they were unable to quit, these
policies will exacerbate already existing smoking- and surgery-related disparities among those who are
socioeconomically disadvantaged. The impact of these policies on smoking- and surgery-related outcomes
among patients of lower SES are unknown. To address this knowledge gap, we will conduct a quasi-
experimental study using a sequential mixed methods design. We will link electronic health record (EHR) data
to Medicaid claims from 148 Oregon community health centers (CHCs) to examine changes in smoking-
(cessation assistance and quit rates) and surgery- (rates of surgery and surgery complications) related
outcomes among patients seeking elective orthopedic surgeries between 1/1/2014-12/31/2016 (pre-policy) and
1/1/2017-12/31/2019 (post-policy implementation). Informed by our quantitative analyses, we will conduct
semi-structured interviews with health care leaders, primary care clinicians, orthopedic surgeons, and patients,
and survey Care Coordination Organization leaders to explore organizational workflows and protocols related
to this policy (e.g., increased cessation assistance), and perceptions and experiences of the policy on intended
and unintended consequences. This innovative study will provide rigorous, actionable evidence to inform
states and policy makers of the extent to which this policy results in the desired changes.

## Key facts

- **NIH application ID:** 10934574
- **Project number:** 5R01MD018368-02
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** Steffani R Bailey
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $610,088
- **Award type:** 5
- **Project period:** 2023-09-25 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10934574

## Citation

> US National Institutes of Health, RePORTER application 10934574, ASSIST: Assessment of Medicaid policy on Smoking Cessation Assistance and Surgical Outcomes (5R01MD018368-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10934574. Licensed CC0.

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