title: Fostering a culture of prevention in a residency program through a continuous quality improvement project.
abstract: This project explored the effect of a multifaceted quality improvement (QI) intervention at a university-based residency program clinic on the documented provision of preventive services. The intervention, based on the Put Prevention Into Practice program and standard QI techniques, consisted of patient self-administered Health Risk Profiles (HRPs) and a monthly educational curriculum for patients, staff, and providers. Documentation of preventive services in patient charts was measured using a repeated cross-sectional sampling design before and after the 1-year intervention period. Documentation of 8 of 19 preventive services under examination increased significantly (P < .05). Measurements of the intervention, including use of the HRPs and the educational curriculum, revealed little association with the observed improvements. Although the intervention was associated with improved documentation of clinical preventive services, specific elements of the intervention were underused. The authors postulate that the QI process fostered a culture change in the clinic that affected prevention activities. Whether the increased documentation of services reflected an increase in the actual provision of services and whether this increase is clinically significant require further study.
authors.affiliation: UT Southwestern Medical Center, Dallas, TX 75390-9067, USA. gregory.schneider@utsouthwestern.edu
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Schneider
authors.forename: Mark
authors.initials: M
authors.lastname: DeHaven
authors.forename: Laura M
authors.initials: LM
authors.lastname: Snell
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice / Q000193:education*; D005260:Female; D006302:Health Services Research; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008875:Middle Aged; D019982:Organizational Case Studies; D015279:Organizational Culture; D010044:Outpatient Clinics, Hospital / Q000592:standards; D011314:Preventive Health Services / Q000592:standards / Q000706:statistics & numerical data*; D015397:Program Evaluation; D018570:Risk Assessment; D012649:Self Concept; D017749:Total Quality Management / Q000458:organization & administration*