Practice based education to improve delivery systems for prevention in primary care: randomised trial.
OBJECTIVE
To examine the effectiveness of an intervention that combined continuing medical education with process improvement methods to implement "office systems" to improve the delivery of preventive care to children.


METHODS
Randomised trial in primary care practices.


METHODS
Private paediatric and family practices in two areas of North Carolina.


METHODS
Random sample of 44 practices allocated to intervention and control groups.


METHODS
Practice based continuing medical education in which project staff coached practice staff in reviewing performance and identifying, testing, and implementing new care processes (such as chart screening) to improve delivery of preventive care.


METHODS
Change over time in the proportion of children aged 24-30 months who received age appropriate care for four preventive services (immunisations, and screening for tuberculosis, anaemia, and lead).


RESULTS
The proportion of children per practice with age appropriate delivery of all four preventive services changed, after a one year period of implementation, from 7% to 34% in intervention practices and from 9% to 10% in control practices. After adjustment for baseline differences in the groups, the change in the prevalence of all four services between the beginning and the end of the study was 4.6-fold greater (95% confidence interval 1.6 to 13.2) in intervention practices. Thirty months after baseline, the proportion of children who were up to date with preventive services was higher in intervention than in control practices; results for screening for tuberculosis (54% v 32%), lead (68% v 30%), and anaemia (79% v 71%) were statistically significant (P < 0.05).


CONCLUSIONS
Continuing education combined with process improvement methods is effective in increasing rates of delivery of preventive care to children.
Margolis
Peter A
PA
University of North Carolina at Chapel Hill, North Carolina Center for Children's Healthcare Improvement, 730 Airport Rd, Ste 104, CB#7226, Chapel Hill, NC 27599, USA. Peter_Margolis@med.unc.edu
Lannon
Carole M
CM
Stuart
Jayne M
JM
Fried
Bruce J
BJ
Keyes-Elstein
Lynette
L
Moore
Donald E
DE
D000740:Anemia / Q000517:prevention & control; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000592:standards*; D004502:Education, Medical, Continuing / Q000379:methods*; D005194:Family Practice / Q000193:education / Q000592:standards; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D007855:Lead Poisoning / Q000517:prevention & control; D009657:North Carolina; D011314:Preventive Health Services / Q000592:standards*; D011315:Preventive Medicine / Q000193:education*; D011320:Primary Health Care / Q000592:standards*; D011331:Private Practice; D015397:Program Evaluation; D014376:Tuberculosis / Q000517:prevention & control