The delivery of clinical preventive services: acute care intervention.
BACKGROUND
. Evidence-based clinical preventive services are underutilized. We explored the major factors associated with delivery of these services in a large physician-owned community-based group practice that provided care for both fee-for-service (FFS) and health maintenance organization (HMO) patient populations.


METHODS
We performed a cross-sectional audit of the computerized billing data of all adult outpatients seen at least once by any primary care provider in 1995 (N = 75,621). Delivery of preventive services was stratified by age, sex, visit frequency, insurance status (FFS or HMO), and visit type (acute care only or scheduled preventive visit).


RESULTS
Insurance status and visit type were the strongest predictors of clinical preventive service delivery. Patients with FFS coverage received 6% to 13% (absolute difference) fewer of these services than HMO patients. Acute-care-only patients received 9% to 45% fewer services than patients who scheduled preventive visits. The combination of these factors was associated with profound differences.


CONCLUSIONS
Having insurance to pay for preventive services is an important factor in the delivery of such care. Encouraging all patients to schedule preventive visits has been suggested as a strategy for increasing delivery, but that is not practical in this setting. Assessing the need for preventive services and offering them during acute care visits has equal potential for increasing delivery.
Hahn
D L
DL
Dean Medical Center, USA. dlhahn@facstaff.wisc.edu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D005375:Financial Audit; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D014922:Wisconsin