DELIVERING CLINICAL PREVENTIVE SERVICES IS A SYSTEMS PROBLEM

A steadily increasing number of research trials and prevention advocat es are identifying the practice environment as the main source of both problems and solutions to the improved delivery of clinical preventiv e services. Although these sources are correctly focusing on office sy stems as solutions, there is a tendency to focus on only parts of a sy stem and to relate this to just one or a few related preventive servic es. However the effort required to set lip and maintain an office syst em makes it difficult to justify doing so for a single clinical activi ty. The process and system thinking of Continuous Quality Improvement (Cel) theory suggests that there may be both efficiency and effectiven ess advantages to the concept of all clinical preventive services bein g sewed by a single system with many interrelated component processes. Such a system should be usable for all age groups. This system and it s literature base are described. The feasibility of applying this conc ept is being tested in a randomized controlled trial in 44 primary car e clinics in Minnesota and Wisconsin.