Improving preventive service delivery through office systems

Objective. Rates of childhood immunizations and other preventive services a re lower in many practices than national goals and providers' own estimates . Office systems have been used in adult settings to improve the delivery o f preventive care, but their effectiveness in pediatric practices is unknow n. This study was designed to determine whether a group of primary care pra ctices in 1 community could implement office-based quality improvement syst ems that would significantly 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 = 8 practices). Project staff worked onsite with improvement teams in each practice to develop tailored s ystems to assess and improve the delivery of immunizations and screening fo r anemia, tuberculosis, and lead exposure. Office-based quality improvement systems typically involved some combination of chart prescreening, risk as sessment forms, Post-it prompts, flowsheets, reminder/recall systems, and p atient education materials. Office systems also often involved redistributi ng responsibilities among office staff. Results. All 8 participating practices created improvement teams. Project s taff met with the practices 10 to 15 times over 12 months. After the period of office assistance, the overall rates for all preventive services except tuberculosis screening increased by amounts that were both clinically and statistically significant. Absolute percent improvements included: complete immunizations at 12 months, 7%; complete immunizations at 24 months, 12%; anemia screening, 30%; lead screening, 36%. The amount of improvement achie ved varied considerably between practices. Conclusions. Office systems and the principles of quality improvement that underlie them seem to be effective in improving the delivery of childhood p reventive services. Important predisposing factors may exist within practic es that affect the likelihood that an individual practice will make signifi cant improvements.