HELPING PRACTICES REACH PRIMARY-CARE GOALS - LESSONS FROM THE LITERATURE

We reviewed rigorous evaluations of programs to enhance the quality an d economy of primary care. We identified 36 evaluations published from 1980 through 1992. We abstracted data on objectives, setting(s), pati ents and processes, outcomes, and costs of care. We identified success ful programs, as well as significant gaps in our knowledge of how to i mprove aspects of care, In specific, computer reminders and social inf luence-based methods fostered preventive and economic care. Nurse impl ementation of prevention protocols increased their performance. Multid isciplinary teams improved access and economy. Regional organization o f practices or telephone management improved access; regionalization a lso reduced emergency care. Improvements were not found in continuity, comprehensiveness, humanistic process, physical environment, or healt h outcomes. Primary care practices can implement several programs to c ontinuously improve prevention and access, and to reduce costs and use of unnecessary services. Research documenting how to accomplish other major goals, including health outcome changes, in different practice types is needed.