Assessment of preventive health care: design considerations.
OBJECTIVE
To design an instrument to assess the performance of a clinic in the delivery of preventive health services to a general population.


METHODS
The study utilized a chart review of services delivered, abstraction of data from electronic databases, and a standardized provider assessment of each eligible patient. The study was conducted in a primary care clinic staffed primarily by internal medicine residents in an urban academic medical center. Patients who were receiving continuity care in the clinic and who were scheduled for an appointment during the 2-week study period were eligible for inclusion. Patients were identified prospectively from the appointment schedule. Charts were reviewed for the delivery of preventive health services prior to the patient's visit. Assessment forms were provided to the primary providers for review and completion. Demographic and appointment information was electronically abstracted from current databases.


RESULTS
The rate at which services were provided varied considerably by service and over time. The reasons for nondelivery included disagreement with guidelines, patient resistance/refusal, and lack of priority.


CONCLUSIONS
It should be possible to assess a clinic's performance over a range of services over its entire population over time. There may be legitimate reasons for services not being provided to a sizable proportion of the population. These issues are complex and require sensitive detailed investigation.
Hershey
C O
CO
Department of Medicine, State University of New York at Buffalo 14215, USA.
Karuza
J
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005260:Female; D005568:Forms and Records Control; D006302:Health Services Research / Q000379:methods*; D006779:Hospitals, Public; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010342:Patient Acceptance of Health Care; D010414:Pennsylvania; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services / Q000592:standards*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D014504:Urban Health