title: Influence of primary care practice and provider attributes on preventive service delivery.
abstract: BACKGROUND
  While visits to the doctor's office are appropriate times to advise patients on health behaviors, these opportunities are often missed. Lapses in care quality are no longer attributed solely to individuals, but are also increasingly understood to be the result of organizational factors. This research examines the influence that both practice and provider attributes have on the delivery of preventive services for health behaviors.
  
  
  METHODS
  This study used data collected from the Prescription for Health initiative sponsored by the Robert Wood Johnson Foundation. Quantitative data on 52 primary care practices and 318 healthcare providers were gathered from September 2003 to September 2004, and were analyzed upon completion of data collection. Hierarchical linear modeling was used to examine associations between both practice and provider attributes and preventive service delivery.
  
  
  RESULTS
  Practice staff participation in decisions regarding quality improvement, practice change, and clinical operations positively influenced the effect of work relationships and negatively influenced the effect of practice size on service delivery. Nurse practitioners and allied health professionals reported more frequent delivery of services compared to physicians. Last, use of reminder systems and patient registries were positively associated with preventive service delivery.
  
  
  CONCLUSIONS
  This study offers preliminary support for staff participation in practice decisions as a positive aspect of teamwork and collaboration. Findings also suggest leveraging nonphysician clinical staff and organized clinical systems to improve the delivery of preventive services for health behaviors.
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of California-Berkeley, USA.
authors.forename: Dorothy Y
authors.initials: DY
authors.lastname: Hung
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Rundall
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
authors.forename: Alfred F
authors.initials: AF
authors.lastname: Tallia
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Helen A
authors.initials: HA
authors.lastname: Halpin
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011314:Preventive Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States