Improving Preventive Service Delivery Through Office Systems

Objective. Rates of childhood immuni- zations and other preventive services are lower in many practices than national goals and providers' own esti- mates. Office systems have been used in adult settings to improve the delivery of preventive care, but their effec- tiveness in pediatric practices is unknown. This study was designed to determine whether a group of primary care practices in 1 community could implement office- based quality improvement systems that would signifi- cantly improve their delivery of childhood preventive services. The study was part of a larger community-wide intervention study reported in a preceding study. Methods. All the major providers of primary care to children in 1 community were recruited and agreed to participate (N 5 8 practices). Project staff worked onsite with improvement teams in each practice to develop tailored systems to assess and improve the delivery of immunizations and screening for anemia, tuberculosis, and lead exposure. Office-based quality improvement systems typically involved some combination of chart prescreening, risk assessment forms, Post-it prompts, flowsheets, reminder/recall systems, and patient educa- tion materials. Office systems also often involved redis- tributing responsibilities among office staff. Results. All 8 participating practices created improve- ment teams. Project staff met with the practices 10 to 15 times over 12 months. After the period of office assis- tance, the overall rates for all preventive services except tuberculosis screening increased by amounts that were both clinically and statistically significant. Absolute per- cent improvements included: complete immunizations at 12 months, 7%; complete immunizations at 24 months, 12%; anemia screening, 30%; lead screening, 36%. The amount of improvement achieved varied considerably between practices. Conclusions. Office systems and the principles of quality improvement that underlie them seem to be ef- fective in improving the delivery of childhood preven- tive services. Important predisposing factors may exist within practices that affect the likelihood that an indi- vidual practice will make significant improvements. Pediatrics 2001;108(3). URL: http://www.pediatrics.org/ cgi/content/full/108/3/e41; prevention, immunizations, im- provement, office systems, primary care. ABBREVIATIONS. TB, tuberculosis; HMO, health maintenance organization; RN, registered nurse; F/U, follow-up.