Use of clinical indicators to evaluate COPC projects.
BACKGROUND
In 1989, Ramsey Family and Community Medicine Residency adopted a population-based focus for teaching and clinical activities based on the principles of community-oriented primary care (COPC). Evaluation and outcomes measurement proved problematic for each of the five COPC projects we implemented.


METHODS
Surrogate measures, or key clinical indicators, were used to monitor the following COPC projects at Ramsey Family Physicians clinic: preschool immunization, family-centered birth, intimate interpersonal violence, teenage pregnancy-sexually transmitted disease prevention, and human immunodeficiency virus (HIV) screening.


RESULTS
Between 1995 and 1998, we documented a decline in preschool immunization rates, an increase in preterm births and low-birth-weight infants, improved intimate interpersonal violence screening, a high but stable teenage pregnancy rate, a decrease in teenage chlamydia rate, and improved HIV prenatal screening. Our data collection and analysis were complicated by a lack of relevant indicators related to target goals, a shifting denominator, incomplete data and an unstable numerator, disconnected data sources, and missing comparison data.


CONCLUSIONS
COPC project evaluation is an evolving process, and measurement deficiencies become recognized with time. Even so, outcomes measurement legitimizes COPC interventions and provides a value-added component to resident education and clinical activities.
D000293:Adolescent; D003151:Community Health Centers / Q000458:organization & administration*; D017579:Domestic Violence / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis; D006305:Health Status Indicators; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation / Q000379:methods