Improving delivery of clinical preventive services: a multi-year journey.
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.
Ballard
David J
DJ
Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas 75206, USA. dj.ballard@baylorhealth.edu
Nicewander
David A
DA
Qin
Huanying
H
Fullerton
Cliff
C
Winter
F David
FD
Couch
Carl E
CE
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