title: Improving adolescent preventive services through state, managed care, and community partnerships.
abstract: OBJECTIVE
  To develop and evaluate a multipronged, guideline-based initiative to improve quality of adolescent preventive care.
  
  
  METHODS
  Activities included: (a) academic institution-based grand rounds and insurance company-sponsored community rounds continuing education sessions on preventive care for primary care clinicians, (b) academic detailing during chart review visits to practices by nurse reviewers, to encourage adolescent-specific confidentiality policies and use of screener or trigger questionnaires during well visits, and (c) partnerships with community corporate leaders to promote awareness of quality preventive services. Interventions were evaluated by comparing 2000 and 2001 chart reviews for rates of tobacco use, substance use, and human immunodeficiency virus (HIV) prevention screening and counseling.
  
  
  RESULTS
  A total of 285 clinicians attended continuing education (CE) sessions and 96 offices received detailing visits. Improvements in adolescent preventive health services delivery were noted in both commercial and Medicaid populations. We found the following when comparing 2001 results with those from 2000: Tobacco use screening or counseling increased from 42.5% to 45.5% for the commercial population and from 32.0% to 43.5% for the Medicaid population; substance use screening increased from 42.5% to 44.0% for the commercial population and from 32.0% to 43.5% for the Medicaid population. HIV counseling increased from 26.5% to 35.5% for the commercial population, and from 28.0% to 40.0% for the Medicaid population (all Medicaid and HIV differences are significant at p <.05).
  
  
  CONCLUSIONS
  These activities have been successful in improving adolescent preventive services for Medicaid populations in New York. Academic detailing can assist health plans in promoting preventive care improvements by primary care clinicians. Further measurement is needed to assess the effect on commercially insured populations.
authors.affiliation: Division of Adolescent Medicine, Strong Children's Research Center, University of Rochester, 601 Elmwood Avenue, Box 690, Rochester, NY 14642, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Klein
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Sesselberg
authors.forename: Beth
authors.initials: B
authors.lastname: Gawronski
authors.forename: Lisa
authors.initials: L
authors.lastname: Handwerker
authors.forename: Foster
authors.initials: F
authors.lastname: Gesten
authors.forename: Anne
authors.initials: A
authors.lastname: Schettine
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards*; D054598:Blue Cross Blue Shield Insurance Plans / Q000458:organization & administration; D018672:Community Health Planning / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003299:Cooperative Behavior; D004496:Education, Continuing; D006801:Humans; D007373:Interinstitutional Relations; D008329:Managed Care Programs / Q000458:organization & administration; D008484:Medicaid / Q000458:organization & administration; D009518:New York; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000592:standards*; D015397:Program Evaluation; D011635:Public Health Administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration*