USING CONTINUOUS QUALITY IMPROVEMENT TO INCREASE PREVENTIVE SERVICES IN CLINICAL-PRACTICE - GOING BEYOND GUIDELINES

Background. Even the most uniformly accepted prevention guidelines do not by themselves lead to implementation or to adequate rates of preve ntive services in medical practice. Although much has been learned abo ut the office systems that seem to be needed for major change in a bus y clinical practice, there are still no examples of a model for develo ping, implementing, and sustaining those office systems in a nonacadem ic practice. Methods. IMPROVE, the first large randomized controlled t rial of CQI (continuous quality improvement) in any industry, is provi ding a scientific test of the hypothesis that HMO sponsorship of a CQI -based intervention can lead to sustained organizational change, imple mentation and maintenance of office systems, and improved rates of adu lt preventive services in contracted private primary care clinics. The 22 clinics assigned to the intervention arm of the study are receivin g training, consultation, networking, and reinforcement for internal m ultidisciplinary teams as they work through a structured process to un derstand and improve their clinic's process for providing preventive s ervices. Rates and quality of eight preventive services in these clini cs are being compared over time with those in 22 matched comparison cl inics. Results. The 44 clinics needed for the trial have been recruite d and randomized, and baseline comparisons show no significant differe nces between the two groups. Nine months into the trial, 21 of 22 inte rvention clinics have completed training and are pursuing a systematic improvement process for preventive ser vices. Conclusions. With exter nal training and consultation, many private primary care clinics will voluntarily engage in a lengthy multidisciplinary team effort to use C QI techniques to study and systematically improve their entire process for providing preventive services. (C) 1996 Academic Press, Inc.