Improving preventive health services training in chiropractic colleges part II: enhancing outcomes through improved training and accountability processes.
OBJECTIVE
Over the past decade, chiropractic colleges have introduced clinical prevention services (CPS) training. This has included an updated public health curriculum and procedures for student interns to determine the need for preventive services and to provide these services directly or through referral to other health professionals. The purpose of this study was to evaluate the effect of a program to train chiropractic interns to deliver CPS to patients.


METHODS
Program evaluation used retrospective chart review, comparing the proportion of patients receiving CPS recommendations before and after implementation of the program. The main outcome measures were the percentage of appropriate CPS recommendations based upon chart reviews.


RESULTS
Chart reviews in 2006 indicated appropriate CPS recommendations in 47.4% of cases (295/623). Chart reviews in 2007, after an additional year of sustained implementation of procedures to ensure intern and faculty accountability, showed appropriate counseling recommendations in 87% of files (137/156).


CONCLUSIONS
Requiring interns to attend didactic presentations on CPS had no measurable effect on their performance. Major improvements occurred after a series of clinically relevant training interventions; new forms and audit procedures were implemented to increase intern and clinical faculty accountability.
Globe
Gary
G
Cleveland Chiropractic College, Los Angeles, CA 90004, USA. gary.globe@cleveland.edu
Redwood
Daniel
D
Brantingham
James W
JW
Hawk
Cheryl
C
Terre
Lisa
L
Globe
Denise
D
Mayer
Stephan
S
D002684:Chiropractic / Q000193:education / Q000458:organization & administration; D002983:Clinical Competence; D003479:Curriculum / Q000592:standards; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D015141:Los Angeles; D008485:Medical Audit; D017145:Models, Educational; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010819:Physician's Role / Q000523:psychology; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000458:organization & administration*; D011315:Preventive Medicine / Q000193:education* / Q000458:organization & administration; D015397:Program Evaluation; D011634:Public Health / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies; D012941:Social Responsibility; D017749:Total Quality Management