title: The case of the missing clinical preventive services systems.
abstract: OBJECTIVE
  To examine the presence and comprehensiveness of organized processes and systems in a sample of primary care clinics shown to have high variation in rates of providing preventive services.
  
  
  METHODS
  Survey study.
  
  
  METHODS
  44 primary care clinics recruited for a scientific trial of a quality improvement intervention to improve preventive services.
  
  
  METHODS
  647 clinicians and nurses.
  
  
  METHODS
  The presence of 10 organized prevention processes for eight adult preventive services as reported by those clinicians and nurses on a detailed written survey.
  
  
  RESULTS
  In more than 50% of clinics, 7 of the 10 prevention processes were reported to be absent for all eight services. Only the follow-up process was commonly present; this was also the only process that was usually present for most applicable services.
  
  
  CONCLUSIONS
  The paucity of recognizable organized processes to support the systematic delivery of adult preventive services in clinics with highly varying rates of providing these services supports the idea that lack of systems may be an important source of the variability and low rates. Most of the existing processes are fragmented and do not function across multiple preventive services.
authors.affiliation: Group Health Foundation/Health Partners, Minneapolis, MN, USA.
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: S A
authors.initials: SA
authors.lastname: Conn
authors.forename: S
authors.initials: S
authors.lastname: Magnan
authors.forename: G
authors.initials: G
authors.lastname: Amundson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D008910:Minnesota; D011314:Preventive Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care; D013647:Task Performance and Analysis