{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T18:08:02Z","timestamp":1777745282208,"version":"3.51.4"},"reference-count":33,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005188","name":"Tobacco-Related Disease Research Program","doi-asserted-by":"publisher","award":["28IR-0056"],"award-info":[{"award-number":["28IR-0056"]}],"id":[{"id":"10.13039\/100005188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Implementation Research and Practice"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In 2016, the California Department of Healthcare Services (DHCS) released an \u201cAll Plan Letter\u201d (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage among Medicaid beneficiaries. However, implementation remains poor. We apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify barriers and facilitators to fidelity to APL 16-014 across California Medicaid MCPs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed fidelity through semi-structured interviews with MCP health educators ( N\u2009=\u200924). Interviews were recorded, transcribed, and reviewed to develop initial themes regarding barriers and facilitators to implementation. Initial thematic summaries were discussed and mapped onto EPIS constructs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The APL (Innovation) was described as lacking clarity and specificity in its guidelines, hindering implementation. Related to the Inner Context, MCPs described the APL as beyond the scope of their resources, pointing to their own lack of educational materials, human resources, and poor technological infrastructure as implementation barriers. In the Outer Context, MCPs identified a lack of incentives for providers and beneficiaries to offer and participate in tobacco-cessation programs, respectively. A lack of communication, educational materials, and training resources between the state and MCPs (missing Bridging Factors) were barriers to preventing MCPs from identifying smoking rates or gauging success of tobacco-cessation efforts. Facilitators included several MCPs collaborating with each other and using external resources to promote tobacco cessation. Additionally, a few MCPs used fidelity monitoring staff as Bridging Factors to facilitate provider training, track providers\u2019 identification of smokers, and follow-up with beneficiaries participating in tobacco-cessation programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The release of the evidence-based APL 16-014 by California's DHCS was an important step forward in promoting tobacco-cessation services for Medicaid MCP beneficiaries. Improved communication on implementation in different environments and improved Bridging Factors such as incentives for providers and patients are needed to fully realize policy goals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plan Language Summary<\/jats:title>\n                    <jats:p>In 2016, the California Department of Healthcare Services (DHCS) in California released an \u201cAll Plan Letter\u201d (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage to address tobacco use among Medicaid beneficiaries. We conducted semi-structured interviews with health educators in California Medicaid MCPs to explore the barriers and facilitators to implementing the APL using the Exploration, Preparation, Implementation, Sustainment framework. According to MCPs, barriers included a lack of clarity in the APL guidelines; a lack of resources, including educational materials, infrastructure to identify smokers, and human resources; and a lack of incentives or penalties for providers to provide tobacco-cessation materials to beneficiaries. Facilitators included collaboration between MCPs and state and\/or national public health programs. Overall, our findings can provide avenues for improving the implementation of tobacco-cessation services within Medicaid MCPs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26334895221096289","type":"journal-article","created":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T03:33:59Z","timestamp":1651116839000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans"],"prefix":"10.1177","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2752-3907","authenticated-orcid":false,"given":"Melina A.","family":"Economou","sequence":"first","affiliation":[{"name":"Department of Anthropology, University of California, San Diego, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonnie N.","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Department of Anthropology, University of California, San Diego, CA, USA"},{"name":"Global Health Program, University of California, San Diego, CA, USA"},{"name":"UC San Diego ACTRI Dissemination and Implementation Science Center, San Diego, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara W.","family":"Yoeun","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika L.","family":"Crable","sequence":"additional","affiliation":[{"name":"UC San Diego ACTRI Dissemination and Implementation Science Center, San Diego, CA, USA"},{"name":"Department of Psychiatry, University of California, San Diego, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3235-6936","authenticated-orcid":false,"given":"Sara B.","family":"McMenamin","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,4,28]]},"reference":[{"key":"bibr1-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0327-7"},{"key":"bibr2-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-01007-w"},{"key":"bibr3-26334895221096289","volume-title":"Bright futures: Guidelines for health supervision of infants, children, and adolescents","author":"American Academy of Pediatrics","year":"2008","edition":"3"},{"key":"bibr4-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.07.015"},{"key":"bibr5-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.1330"},{"issue":"55","key":"bibr6-26334895221096289","first-page":"1","volume":"15","author":"Bunger A. C.","year":"2020","journal-title":"Implementation Science"},{"key":"bibr7-26334895221096289","first-page":"9716740","author":"Crable E.","journal-title":"Journal of Health Politics, Policy, and Law"},{"issue":"1","key":"bibr8-26334895221096289","first-page":"1","volume":"17","author":"Crable E. L.","journal-title":"Implementation Science"},{"key":"bibr9-26334895221096289","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6845a2"},{"key":"bibr10-26334895221096289","volume-title":"Treating tobacco use and dependence (No. 18)","author":"Fiore M. C.","year":"2000"},{"key":"bibr11-26334895221096289","volume-title":"Treating tobacco use and dependence: 2008 update","author":"Fiore M. C.","year":"2008"},{"issue":"7","key":"bibr12-26334895221096289","first-page":"1","author":"Flodgren G.","year":"2011","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"bibr13-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-84"},{"key":"bibr14-26334895221096289","unstructured":"Kaiser Family Foundation [KFF] (2020). Total Medicaid MCO enrollment as of July 1, 2018. https:\/\/www.kff.org\/other\/state-indicator\/total-medicaid-mco-enrollment\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D."},{"key":"bibr15-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-021-01099-y"},{"key":"bibr16-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-00999-9"},{"key":"bibr17-26334895221096289","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/13-159"},{"key":"bibr18-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1177\/2633489520940022"},{"key":"bibr19-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.01.016"},{"key":"bibr20-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2020.04.007"},{"key":"bibr21-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4527-x"},{"key":"bibr22-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-018-0842-6"},{"issue":"7","key":"bibr23-26334895221096289","first-page":"1","author":"Notley C.","year":"2019","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"bibr24-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-019-0876-4"},{"key":"bibr25-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-015-0209-1"},{"key":"bibr26-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-015-0367-1"},{"key":"bibr27-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-6210.2006.00598.x"},{"key":"bibr28-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-91"},{"key":"bibr29-26334895221096289","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.07.031"},{"key":"bibr30-26334895221096289","volume-title":"Smoking cessation, clinical practice guideline, No. 18","author":"United States Department of Health and Human Services [USDHHS]","year":"1996"},{"key":"bibr31-26334895221096289","volume-title":"Tobacco use in children and adolescents: Primary care interventions","author":"United States Preventive Services Task Force [USPSTF]","year":"2013"},{"key":"bibr32-26334895221096289","volume-title":"Tobacco smoking cessation in adults, including pregnant women: Behavioral and pharmacotherapy interventions","author":"United States Preventive Services Task Force [USPSTF]","year":"2015"},{"key":"bibr33-26334895221096289","first-page":"35","volume-title":"Smoking cessation: A report of the surgeon general","author":"United States Public Health Service Office of the Surgeon General [USPHSOSG]","year":"2020"}],"container-title":["Implementation Research and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/26334895221096289","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/26334895221096289","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/26334895221096289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:40:20Z","timestamp":1777462820000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/26334895221096289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":33,"alternative-id":["10.1177\/26334895221096289"],"URL":"https:\/\/doi.org\/10.1177\/26334895221096289","relation":{},"ISSN":["2633-4895","2633-4895"],"issn-type":[{"value":"2633-4895","type":"print"},{"value":"2633-4895","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]},"article-number":"26334895221096289"}}