title: Using continuous quality improvement to increase preventive services in clinical practice--going beyond guidelines.
abstract: BACKGROUND
  Even the most uniformly accepted prevention guidelines do not by themselves lead to implementation or to adequate rates of preventive services in medical practice. Although much has been learned about the office systems that seem to be needed for major change in a busy clinical practice, there are still no examples of a model for developing, implementing, and sustaining those office systems in a nonacademic practice.
  
  
  METHODS
  IMPROVE, the first large randomized controlled trial of CQI (continuous quality improvement) in any industry, is providing a scientific test of the hypothesis that HMO sponsorship of a CQI-based intervention can lead to sustained organizational change, implementation and maintenance of office systems, and improved rates of adult preventive services in contracted private primary care clinics. The 22 clinics assigned to the intervention arm of the study are receiving training, consultation, networking, and reinforcement for internal multidisciplinary teams as they work through a structured process to understand and improve their clinic's process for providing preventive services. Rates and quality of eight preventive services in these clinics are being compared over time with those in 22 matched comparison clinics.
  
  
  RESULTS
  The 44 clinics needed for the trial have been recruited and randomized, and baseline comparisons show no significant differences between the two groups. Nine months into the trial, 21 of 22 intervention clinics have completed training and are pursuing a systematic improvement process for preventive services.
  
  
  CONCLUSIONS
  With external training and consultation, many private primary care clinics will voluntarily engage in a lengthy multidisciplinary team effort to use CQI techniques to study and systematically improve their entire process for providing preventive services.
authors.affiliation: Group Health Foundation, Minneapolis, Minnesota 55440, USA. Leif.I.Solberg@HealthPartners.com
authors.forename: L I
authors.initials: LI
authors.lastname: Solberg
authors.forename: T E
authors.initials: TE
authors.lastname: Kottke
authors.forename: M L
authors.initials: ML
authors.lastname: Brekke
authors.forename: C A
authors.initials: CA
authors.lastname: Calomeni
authors.forename: S A
authors.initials: SA
authors.lastname: Conn
authors.forename: G
authors.initials: G
authors.lastname: Davidson
mesh_terms: D000328:Adult; D004059:Diffusion of Innovation; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D007324:Institutional Management Teams; D008485:Medical Audit; D008910:Minnesota; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011216:Practice Management, Medical; D011314:Preventive Health Services / Q000458:organization & administration*; D013192:Staff Development / Q000379:methods*; D017749:Total Quality Management