ORIGINAL RESEARCH
Steffani R. Bailey, PhD; Nathalie Huguet, PhD; Kathryn J. Bonuck, MSEd; Maria N. Danna, MA; Shannon M. Sweeney, MPH, PhD; Catherine J. Livingston, MD, MPH; Deborah J. Cohen, PhD
Corresponding Author: Nathalie Huguet, PhD; Oregon Health & Science University, Department of Family Medicine.
Email: huguetn@ohsu.edu
DOI: 10.3122/jabfm.2026.260155R2
Keywords: Continuity of Care, Health Disparities, Health Policy, Implementation Science, Medicaid, Oregon, Postoperative Complications, Smoking Cessation, Surgery, Surveys and Questionnaires
Dates: Submitted: 4/16/2026; Revised: 7/8/2026; 8/13/2026; Accepted: 8/24/2026
Status: In Press.
INTRODUCTION: Cigarette smoking is a significant risk factor for the development of postoperative complications. In 2017, the Oregon Health Authority published a Guideline requiring Medicaid-insured patients to be abstinent from cigarette smoking for at least four weeks prior to most elective surgeries as a condition of payment. We surveyed and interviewed coordinated care organization (CCO) leaders to understand the Guideline implementation and to their perceptions of the Guideline’s benefits and harms.
METHODS: Of the 16 Oregon CCOs, 12 completed the survey (75% response rate) and 6 CCO leaders (50% of survey respondents) participated in interviews. Survey questions and interviews focused on processes involved in implementing the Guideline, communication mechanisms and the perceived benefits and unintended consequences associated with the Guideline.
RESULTS: All CCOs implemented the Guideline with variations in the types of cessation assistance permitted, restriction on the types of combustible products, communications of the new rules, and decisions on exceptions. CCO leaders saw this Guideline as mostly beneficial but did have concerns regarding increased inequities related to access to surgery among those with Medicaid insurance.
CONCLUSIONS: While all CCOs implemented most aspects of the Guideline, there were variations regarding types of smoking cessation permitted and the range of permitted exceptions. Overall, the results highlight the need for clear, well-defined implementation protocols and monitoring of roll out to ensure that guidelines are implemented with best practices across health care systems.