A clinical trial of tailored office systems for preventive service delivery - The study to enhance prevention by understanding practice (STEP-UP)

Background: The potential of primary care practice settings to prevent dise ase and morbidity through health habit counseling, screening for asymptomat ic disease, and immunizations has been incompletely met. This study was des igned to test a practice-tailored approach to increasing preventive service delivery with particular emphasis on health habit counseling. Design: Group randomized clinical trial and multimethod process assessment. Setting/Participants: Seventy- seven community family practices in northeas t Ohio. Intervention: After a 1-day practice assessment, a nurse facilitator met wi th practice clinicians and staff and assisted them with choosing and implem enting individualized tools and approaches aimed at increasing preventive s ervice delivery. Main Outcome Measure: Summary scores of the health habit counseling, screen ing and immunization services recommended by the U.S. Preventive Services T ask Force up to date for consecutive patients during randomly selected char t review days. Results: A significant increase (p=0.015) in global preventive service deli very rates at the I-year follow-up was found in the intervention group (31% to 42%) compared to the control group (35% to 37%). Rates specifically for health habit counseling (p=0.007) and screening services (p=0.048) were in creased, but not for immunizations. Conclusions: An approach to increasing preventive service delivery that is individualized to meet particular practice needs can increase global preven tive service delivery rates.