Table 1.

Conceptual model constructs that influenced innovations

Conceptual Model
Component and Rationale	Innovative CEASE aspect influenced by the model
Chronic Care Model [33,34] (Clinical Information Systems) recommends that practices: • Identify relevant subpopulations for proactive care • Facilitate care planning • Share information to coordinate care (information about smoking and tobacco smoke exposure; information about services requested)	Electronic screening for tobacco use and tobacco smoke exposure to screen for: • Tobacco use and exposure • Interest in using smoking cessation medications • Interest in community smoking cessation support services (such as the free state quitline or SmokefreeTXT) Practices are instructed to document household tobacco use status and assistance provided (if any) information in the electronic medical record of the child for care coordination.
Chronic Care Model (the Community) encourages programs to: • Connect patients to effective community programs • Form partnerships with community organizations to support and develop interventions that fill gaps in needed services	CEASE trains pediatric offices to refer tobacco users to free community-based cessation resources such as the state tobacco quitline and SmokefreeTXT
Chronic Care Model (Self-management Support) recommends: • Emphasizing patient’s central role in managing their health • Using effective self-management support strategies that include goal-setting, action planning, problem-solving, and follow-up	CEASE promotes self-management support through training clinicians to help all tobacco users: • Set a quit date • Develop a quit plan, including strategies to overcome barriers to smoking cessation • Use over-the-counter smoking cessation medications to manage cravings while quitting smoking • Establish smoke-free home and car rules
RE-AIM [36,37] (Reach): • Tailor interventions to reach more people	CEASE intervention is tailored based on the needs of individual pediatric practices and families that these practices treat: • Spanish materials are offered in a practice with high Spanish speaking population • The CEASE Action Sheet is individually designed for each practice and resources in each state The flow of screening using the electronic tablet is adapted to the needs and unique situation of the practice
RE-AIM (Implementation): Consistently deliver the main components of the intervention	CEASE staff worked with practices to ensure consistency of key elements of the CEASE intervention, including: • Screening for tobacco use and exposure; • Referral to free cessation services; • Offer and/or prescription of cessation medication)
Sustainability [38–41] Focus on support and education at the health system level practice	CEASE staff supports and educates practices to make changes to their healthcare delivery system to routinely and effectively address family tobacco use and tobacco smoke exposure over time The design of CEASE focuses on maintaining core elements of the intervention while tailoring some aspects to adapt to the needs of the practice over time CEASE advocates for and supports maintaining a local tobacco control champion at the practice CEASE accounts for staff turnover by training new clinicians and staff members as they are hired into the practice CEASE provides support and education on how to acquire resources for tobacco control activities through billing for services