Background. There is increasing evidence that the most effective way to improve delivery of preventive services in primary care is to establish organized preventive service systems. This study tests the hypothesis that a managed care organization (MCO) can help its contracted private primary care clinics to develop such systems. Methods. Forty-four primary care clinics contracting with two large MCOs were randomized to a comparison (C) or an intervention (I) group. Group (I) clinic team leaders received training plus ongoing consultation and networking. Personnel at all 44 clinics completed surveys prior to and at the end of the intervention to measure adoption of the improvement process and the prevention system. Results. All 22 (I) clinics identified teams that appeared to follow the seven-step improvement process. The mean numbers of system processes were identical at baseline, 11.2 (I) vs 12.1 (C), while after the intervention this had changed to 25.8 in (I) clinics vs 11.3 in (C) (P = 0.022). Conclusions. With training and assistance, interested primary care clinic teams will establish functioning CQI teams that will produce a substantial increase in the presence of functional prevention system processes. Whether this change is sufficient to increase the rates of preventive services remains to be documented.
Bibliographical noteFunding Information:
We gratefully acknowledge the support of the sponsoring HMOs (Blue Plus and HealthPartners), Health Partners Research Foundation, and the IMPROVE project staff, especially Jerry Amundson, Brian Harmon, Kathy Schaivone, Katherine Giles, Charlotte Straw, and Carol Westrum. However, we are particularly grateful to the clinicians and staffs in the clinics that have cooperated so well with the surveys described in this article and in the IMPROVE Project overall: HealthPartners St. Paul Clinic, Kasson Mayo Family Practice Clinic, Aspen Medical Group±Bloomington, East Main Physicians, East Side Medical Center, Family Medical Center±Hennepin County, Forest Lake Doctors Clinic, Hudson Physicians, North Clinic, North-port Medical Center, Palen Heights Medical Center, Ramsey Clinic± Osceola, Ramsey Family Physicians, Richfield Medical Group, River Valley±Cottage Grove, River Valley±Hastings, River Valley± Woodbury, River Valley Medical Center±St. Croix Falls, Silver Lake Clinic, Southdale Internal Medicine, Southwest Clinic, St. Croix Valley Clinic, Sundance Medical Center, Valley Family Practice, Apple Valley Medical Center, Aspen Medical Group±West St. Paul, Aspen Medical Group±West Suburban, Chanhassen Medical Center, Chi-sago Medical Center, Creekside Family Practice, Douglas Drive Family Physicians, Eagle Medical, Fridley Medical Center, Hastings Family Practice, Hopkins Family Practice, Interstate Medical Center, Metropolitan Internists, Mork Clinic±Anoka, North St. Paul Medical Center, Ramsey Clinic±Amery, Ramsey Clinic±Baldwin, River Valley Clinic±Farmington, River Valley Clinic±Northfield, Southdale Family Practice, Stillwater Clinic, and United Family Medical Center.
1This project was supported by Grant RO1 HS08091 from the Agency for Health Care Policy and Research. 2 To whom reprint requests should be addressed at HealthPartners Research Foundation, 8100±34th Avenue South, P.O. Box 1309, Min-
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