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Eff Clin Pract. 2000 May-Jun;3(3):105-15.

Failure of a continuous quality improvement intervention to increase the delivery of preventive services. A randomized trial.

Author information

1
HealthPartners Research Foundation, Minneapolis, Minn., USA. leif.i.solberg@healthpartners.com

Abstract

CONTEXT:

Although there has been enormous interest in continuous quality improvement (CQI) as a measure to improve health care, this enthusiasm is based largely on its apparent success in business rather than formal evaluations in health care.

OBJECTIVE:

To determine whether a managed care organization can increase delivery of eight clinical preventive services by using CQI.

DESIGN:

Primary care clinics were randomly assigned to improve delivery of preventive services with CQI (intervention group) or to provide usual care (control group).

INTERVENTION:

Through leadership support, training, consulting, and networking, each intervention clinic was assisted to use CQI multidisciplinary teams to develop and implement systems for delivery of preventive services.

SETTING:

44 primary care clinics in greater Minneapolis-St. Paul.

PATIENTS:

Patients 19 years of age and older completed surveys at baseline (n = 6830) and at follow-up (n = 6431). Medical chart audits were completed on 4777 patients at baseline and 4546 patients at follow-up.

MAIN OUTCOME MEASURES:

The proportion of patients who were up-to-date (according to chart audit) and the proportion of patients who were offered a service if not up-to-date (according to patient report) for 8 preventive services.

RESULTS:

Compared with the control group, based on the proportion of patients who were up-to-date, use of only one preventive service--pneumococcal vaccine--increased significantly in the intervention group (17.2% absolute increase from baseline to follow-up compared with a 0.3% absolute increase in the control group, P = 0.003). Similarly, based on patient report of being offered a service if not up-to-date, delivery of only one preventive service--cholesterol testing--significantly increased in the intervention group compared with the control group (4.6% increase vs. 0.4% absolute decrease in the control group; P = 0.006).

CONCLUSION:

In this trial, CQI methods did not result in clinically important increases in preventive service delivery rates.

Comment in

PMID:
11182958
[Indexed for MEDLINE]

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