Improving prevention systems in primary care practices: the Health Education and Research Trial (HEART)
BACKGROUND
The Health Education and Research Trial (HEART) was a multicenter clinical trial designed to test methods to improve primary care practice systems for heart disease prevention services. We present the trial methodology, the practices' use of medical record tools, and changes in documentation of cardiovascular risk factor screening and management.


METHODS
Primary care practices were recruited from 4 Midwestern states. The factorial design resulted in 4 study groups: conference only, conference and quality improvement consultations, conference and prevention coordinator, and all interventions combined. Medical record audits and physician, staff, and patient surveys assessed practice change in cardiovascular disease risk factor documentation.


RESULTS
Practices participated fully in this project, set goals to improve preventive services, and implemented recommended medical record tools. The number of goals set and the increase in the use of medical record tools were greatest in the combined intervention group, with improvements noted in all groups. The use of patient history questionnaires, problem lists, and flow sheets was significantly higher in the combined intervention group when compared with the conference-only group. Documentation of risk factor screening in a recommended-medical record location improved in all intervention groups, with significant sustained improvements in the practices that received the combined intervention. Documented risk factor management significantly improved in all intervention groups compared with the conference-only control.


CONCLUSIONS
Primary care practices are interested in improving prevention systems and can change these systems in response to supportive external interventions. Promoting organizational change to produce sustained improvement in preventive service clinical outcomes is a complex process that requires further research.
McBride
P
P
Department of Family Medicine, University of Wisconsin Medical School, Madison, USA. pem@medicine.wisc.edu
Underbakke
G
G
Plane
M B
MB
Massoth
K
K
Brown
R L
RL
Solberg
L I
LI
Ellis
L
L
Schrott
H G
HG
Smith
K
K
Swanson
T
T
Spencer
E
E
Pfeifer
G
G
Knox
A
A
D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004282:Documentation; D005194:Family Practice / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008499:Medical Records; D015146:Midwestern United States; D009936:Organizational Innovation; D009937:Organizational Objectives; D011314:Preventive Health Services / Q000458:organization & administration*; D012307:Risk Factors