Improving prevention systems in primary care practices - The Health Education and Research Trial (HEART)

BACKGROUND The Health Education and Research Trial (HEART) was a multicente r clinical trial designed tu teat methods to improve primary care practice systems for heart disease prevention services. We present the trial methodo logy, the practices' use of medical record tools, and changes in documentat ion of cardiovascular risk factor screening and management. METHODS Primary care practices were recruited from 4 Midwestern states. The factorial design resulted in ii study groups: conference only, conference and quality improvement consultations, conference and prevention coordinato r, and all interventions combined. Medical record audits and physician, sta ff and patient surveys assessed practice change in cardiovascular disease r isk factor documentation. RESULTS Practices participated fully in this project, set goals to improve preventive sen ices, and implemented recommended medical record tools, The number of goals set and the increase in the use of medical record tools wer e greatest in the combined intervention group, with improvements noted in a il groups. The use of patient history questionnaires, problem lists, and fl ow sheets was significantly higher in the combined intervention group when compared with the conference only group. Documentation of risk factor scree ning in a recommended medical record location improved in all intervention groups, with significant sustained improvements in the practices that recei ved the combined intervention. Documented risk factor management significan tly improved in all intervention groups compared with the conference-only c ontrol. CONCLUSIONS Primary care practices are interested in improving prevention s ystems and can change these systems in response to supportive external inte rventions. Promoting organizational change to produce sustained improvement in preventive service clinical outcomes is a xcomplex process that require s further research.