title: Improving delivery of clinical preventive services: a multi-year journey.
abstract: BACKGROUND
  Adults in the United States typically do not receive all recommended clinical preventive services (CPS) for which they are eligible, missing opportunities for prevention and/or early detection. A multi-year quality improvement initiative targeting CPS delivery in a fee-for-service ambulatory care network is described.
  
  
  METHODS
  Since 1999, HealthTexas Provider Network (HTPN) has implemented multiple initiatives to increase CPS delivery, including a flowsheet, a physician champion model, physician- and practice-level audit and feedback, and rapid-cycle quality improvement training.
  
  
  RESULTS
  From 2000 to 2006, "recommended or done" CPS delivery increased from 68% to 92%, and "done" from 70% to 86% (2001 to 2006). "Perfect care" composite performance increased from 0.19 to 0.51 (2001 to 2006).
  
  
  CONCLUSIONS
  Long-term, multistrategy approaches can achieve substantial sustained improvement in CPS delivery throughout a large ambulatory care provider network.
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas 75206, USA. dj.ballard@baylorhealth.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
authors.forename: David A
authors.initials: DA
authors.lastname: Nicewander
authors.forename: Huanying
authors.initials: H
authors.lastname: Qin
authors.forename: Cliff
authors.initials: C
authors.lastname: Fullerton
authors.forename: F David
authors.initials: FD
authors.lastname: Winter
authors.forename: Carl E
authors.initials: CE
authors.lastname: Couch
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards*; D019058:Community Networks / Q000458:organization & administration / Q000592:standards; D018588:Fee-for-Service Plans / Q000458:organization & administration / Q000592:standards; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D010865:Pilot Projects; D011314:Preventive Health Services / Q000458:organization & administration / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000592:standards*; D019984:Quality Indicators, Health Care; D013781:Texas; D013997:Time Factors