A clinical trial of tailored office systems for preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP).
BACKGROUND
The potential of primary care practice settings to prevent disease and morbidity through health habit counseling, screening for asymptomatic disease, and immunizations has been incompletely met. This study was designed to test a practice-tailored approach to increasing preventive service delivery with particular emphasis on health habit counseling.


METHODS
Group randomized clinical trial and multimethod process assessment.


METHODS
Seventy-seven community family practices in northeast Ohio.


METHODS
After a 1-day practice assessment, a nurse facilitator met with practice clinicians and staff and assisted them with choosing and implementing individualized tools and approaches aimed at increasing preventive service delivery.


METHODS
Summary scores of the health habit counseling, screening and immunization services recommended by the U.S. Preventive Services Task Force up to date for consecutive patients during randomly selected chart review days.


RESULTS
A significant increase (p=0.015) in global preventive service delivery rates at the 1-year follow-up was found in the intervention group (31% to 42%) compared to the control group (35% to 37%). Rates specifically for health habit counseling (p=0.007) and screening services (p=0.048) were increased, but not for immunizations.


CONCLUSIONS
An approach to increasing preventive service delivery that is individualized to meet particular practice needs can increase global preventive service delivery rates.
Goodwin
M A
MA
Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio 44106, USA. mag@po.cwru.edu
Zyzanski
S J
SJ
Zronek
S
S
Ruhe
M
M
Weyer
S M
SM
Konrad
N
N
Esola
D
D
Stange
K C
KC
D000328:Adult; D003376:Counseling / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009819:Office Visits; D009820:Ohio; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation