Abstract
Objective To examine the effectiveness of an intervention that
combined continuing medical education with process
improvement methods to implement “office systems” to
improve the delivery of preventive care to children.
Design Randomised trial in primary care practices.
Setting Private paediatric and family practices in two areas of
North Carolina.
Participants Random sample of 44 practices allocated to
intervention and control groups.
Intervention Practice based continuing medical education in
which project staff coached practice staff in reviewing
performance and identifying, testing, and implementing new
care processes (such as chart screening) to improve delivery of
preventive care.
Main outcome measure Change over time in the proportion of
children aged 24-30 months who received age appropriate care
for four preventive services (immunisations, and screening for
tuberculosis, anaemia, and lead).
Results The proportion of children per practice with age
appropriate delivery of all four preventive services changed,
after a one year period of implementation, from 7% to 34% in
intervention practices and from 9% to 10% in control practices.
After adjustment for baseline differences in the groups, the
change in the prevalence of all four services between the
beginning and the end of the study was 4.6-fold greater (95%
confidence interval 1.6 to 13.2) in intervention practices. Thirty
months after baseline, the proportion of children who were up
to date with preventive services was higher in intervention than
in control practices; results for screening for tuberculosis (54% v
32%), lead (68% v 30%), and anaemia (79% v 71%) were
statistically significant (P < 0.05).
Conclusion Continuing education combined with process
improvement methods is effective in increasing rates of delivery
of preventive care to children.
randomised trial systems for prevention in primary care: Practice based education to improve delivery