title: Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors.
abstract: This study examines the Chronic Care Model (CCM) as a framework for preventing health risk behaviors such as tobacco use, risky drinking, unhealthy dietary patterns, and physical inactivity. Data were obtained from primary care practices participating in a national health promotion initiative sponsored by the Robert Wood Johnson Foundation. Practices owned by a hospital health system and exhibiting a culture of quality improvement were more likely to offer recommended services such as health risk assessment, behavioral counseling, and referral to community-based programs. Practices that had a multispecialty physician staff and staff dieticians, decision support in the form of point-of-care reminders and clinical staff meetings, and clinical information systems such as electronic medical records were also more likely to offer recommended services. Adaptation of the CCM for preventive purposes may offer a useful framework for addressing important health risk behaviors.
authors.affiliation: Columbia University, Mailman School of Public Health, New York, NY 10032, USA. dh2237@columbia.edu
authors.forename: Dorothy Y
authors.initials: DY
authors.lastname: Hung
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Rundall
authors.forename: Alfred F
authors.initials: AF
authors.lastname: Tallia
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Helen Ann
authors.initials: HA
authors.lastname: Halpin
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D000428:Alcohol Drinking / Q000517:prevention & control; D002908:Chronic Disease / Q000517:prevention & control* / Q000628:therapy; D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical; D017598:Efficiency, Organizational; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D015438:Health Behavior; D006293:Health Promotion / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010067:Ownership / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000458:organization & administration* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012309:Risk-Taking; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D014481:United States