Objective: Tobacco-related disease is a leading cause of premature mortality for people experiencing mental illness. Tobacco treatment is not routinely provided in psychiatry with systemic barriers preventing access to treatment. This study examines a system change approach, with an incentive payment, to implement tobacco treatment at scale in community psychiatry settings.

Methods: Secondary analysis of statewide health administrative data was conducted. Changes in documentation of smoking status and delivery of a tobacco treatment brief intervention (the Pathway) were evaluated using interrupted time series analysis between July 2017 and June 2023. An implementation period (4 years), divided into incentive payment phases for achievement of pre-defined targets, and a post-incentive payment maintenance period (2 years) were defined.

Results: Documented average smoking rate for community psychiatry during maintenance remained high (52.5%; 95% confidence interval = [52.5, 52.6]). Statewide documentation of smoking status significantly exceeded targets during implementation, reaching 93.9% (95% confidence interval = [93.3%, 94.4%]). Despite a 2.1% decrease (95% confidence interval = [-3.4, -0.8]) after removal of incentive payments, reporting remained high 91.9% (95% confidence interval = [91.5%, 92.3%]). Documentation of the Pathway was significantly higher than targets and showed no change by implementation end (87.0%; 95% confidence interval = [85.9%, 88.1%]) to maintenance where no incentive payments were available (85.7%; 95% confidence interval = [84.9%, 86.5%]).

Conclusions: Delivery of tobacco treatment in psychiatry is an important step to addressing inequity in smoking prevalence, but achieving this has been challenging. Our study demonstrates the potential of a system change intervention to improve care and sustainably deliver tobacco cessation treatment, at scale, in psychiatry settings.

Keywords: Health system change; mental illness; smoking cessation; smoking rates; tobacco.

目标： 吸烟相关疾病是精神疾病患者过早死亡的主要原因之一。烟草治疗在精神病学中并未常规提供，系统性障碍阻碍了治疗方法的普及。本研究探讨了一种系统变革方法，并采用激励支付方式，在社区精神病学环境中大规模实施烟草治疗。

方法： 对全省范围内的健康行政数据进行了二次分析。使用中断时间序列分析评估了在2017年7月至2023年6月期间，记录吸烟状况和提供简短的烟草治疗干预（Pathway）的变化情况。定义了一个实施期（4年），分为激励支付阶段以达成预设目标，并且在激励支付结束后设立了一段维护期（2年）。

结果： 在维持期间，社区精神病学的平均吸烟率仍然很高（52.5%；95%置信区间为[52.5, 52.6]）。在实施阶段，全省记录吸烟状况的比例显著超过目标，达到93.9%（95%置信区间为[93.3%，94.4%]）。尽管在取消激励支付后减少了2.1%（95%置信区间为[-3.4, -0.8]），但报告比例仍维持在较高水平，达到91.9%（95%置信区间为[91.5%，92.3%]）。Pathway的记录显著高于目标，并且实施结束后未见变化（87.0%；95%置信区间为[85.9%，88.1%]），在没有激励支付的维护期间，该比例略微下降至85.7%（95%置信区间为[84.9%，86.5%]）。

结论： 在精神病学环境中提供烟草治疗是解决吸烟率差异的重要一步，但实现这一点一直颇具挑战。我们的研究展示了系统变革干预的潜力，能够改善护理，并在精神病学设置中可持续地大规模提供戒烟治疗。

关键词： 健康体系改革；精神疾病；戒烟；吸烟率；烟草。