Low-barrier tobacco screening and cessation outreach: A multisite veterans affairs quality improvement initiative

To describe implementation of a multi-site, equity-informed tobacco screening and cessation outreach initiative across three Veterans Affairs healthcare systems.

This quality improvement initiative was implemented in fiscal year 2025 in San Francisco, California, Danville, Illinois, and Orlando, Florida. The intervention combined dashboard-informed targeting with in-person outreach events offering tobacco use screening, brief education, medications for tobacco use disorder, referral to cessation resources, and selected lung cancer screening education and referral. Outcomes included reach, service delivery outputs, tobacco use screening trends, and implementation barriers and facilitators, summarized descriptively using dashboard and event-level data.

Implementation varied across sites. San Francisco completed four outreach events with 417 total participant encounters, including 212 Veterans, and documented 19 tobacco use screenings, 18 lung cancer screenings, medication linkage, quitline/provider referrals, and research linkage. Danville completed three outreach events reaching 120 Veterans and documented 6 tobacco use screenings and 12 medication prescriptions. Orlando did not complete events because of staffing and operational barriers. Key determinants included staffing capacity, workflow fit, event approvals, procurement, outreach availability, and lung cancer screening infrastructure.

Dashboard-informed outreach may extend tobacco-related preventive care beyond routine clinic encounters, but implementation depends on local infrastructure, staffing, referral pathways, and interdisciplinary partnerships.