Will primary care clinics organize themselves to improve the delivery of preventive services? A randomized controlled trial.
BACKGROUND
There is increasing evidence that the most effective way to improve delivery of preventive services in primary care is to establish organized preventive service systems. This study tests the hypothesis that a managed care organization (MCO) can help its contracted private primary care clinics to develop such systems.


METHODS
Forty-four primary care clinics contracting with two large MCOs were randomized to a comparison (C) or an intervention (I) group. Group (I) clinic team leaders received training plus ongoing consultation and networking. Personnel at all 44 clinics completed surveys prior to and at the end of the intervention to measure adoption of the improvement process and the prevention system.


RESULTS
All 22 (I) clinics identified teams that appeared to follow the seven-step improvement process. The mean numbers of system processes were identical at baseline, 11.2 (I) vs 12.1 (C), while after the intervention this had changed to 25.8 in (I) clinics vs 11.3 in (C) (P = 0.022).


CONCLUSIONS
With training and assistance, interested primary care clinic teams will establish functioning CQI teams that will produce a substantial increase in the presence of functional prevention system processes. Whether this change is sufficient to increase the rates of preventive services remains to be documented.
Health Partners Research Foundation, Minneapolis, Minnesota 55440, USA. Solbergli@HealthPartners.com
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Solberg
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Kottke
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Brekke
D003695:Delivery of Health Care / Q000458:organization & administration*; D005500:Follow-Up Studies; D006801:Humans; D007318:Inservice Training; D007857:Leadership; D008329:Managed Care Programs / Q000458:organization & administration; D011314:Preventive Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration