BMJ, doi: 10.1136/bmj.38009.706319.47, (Published 6 February 2004)

PRIMARY CARE

Practice based education to improve delivery systems for prevention in primary care: randomised trial

Peter A Margolis ¹, Carole M Lannon ¹, Jayne M Stuart ¹, Bruce J Fried ², Lynette Keyes-Elstein ³, Donald E Moore Jr⁴

¹ University of North Carolina at Chapel Hill, North Carolina Center for Children's Healthcare Improvement, 730 Airport Rd, Ste 104, CB#7226, Chapel Hill, NC 27599, USA
² University of North Carolina at Chapel Hill, School of Public Health, Department of Health Policy and Administration, Chapel Hill
³ Rho Inc, Chapel Hill, NC 27514, USA
⁴ Vanderbilt University School of Medicine, Nashville, TN 37232, USA

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.

---

(Accepted )
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Medical education research remains the poor relation

Mathew Todres, Anne Stephenson, and Roger Jones
BMJ 2007 335: 333-335. [Extract] [Full Text] [PDF]

Practice based education increases delivery of preventive health care to children
BMJ 2004 328: 0. [Full Text] [PDF]

This article has been cited by other articles:

• Profit, J., Cambric-Hargrove, A. J., Tittle, K. O., Pietz, K., Stark, A. R. (2009). Delayed Pediatric Office Follow-up of Newborns After Birth Hospitalization. Pediatrics 124: 548-554 [Abstract] [Full text]  
• Davis, D., Galbraith, R. (2009). Continuing Medical Education Effect on Practice Performance: Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest 135: 42S-48S [Abstract] [Full text]  
• Rubenstein, L V, Hempel, S, Farmer, M M, Asch, S M, Yano, E M, Dougherty, D, Shekelle, P W (2008). Finding order in heterogeneity: types of quality-improvement intervention publications. Qual Saf Health Care 17: 403-408 [Abstract] [Full text]  
• Newton, W. P. (2008). Improving Performance in Prevention. J Am Board Fam Med 21: 258-260 [Full text]  
• Mold, J. W., Aspy, C. A., Nagykaldi, Z. (2008). Implementation of Evidence-Based Preventive Services Delivery Processes in Primary Care: An Oklahoma Physicians Resource/Research Network (OKPRN) Study. J Am Board Fam Med 21: 334-344 [Abstract] [Full text]  
• Lannon, C. M., Flower, K., Duncan, P., Moore, K. S., Stuart, J., Bassewitz, J. (2008). The Bright Futures Training Intervention Project: Implementing Systems to Support Preventive and Developmental Services in Practice. Pediatrics 122: e163-e171 [Abstract] [Full text]  
• Gallis, H. A. (2008). Quality Improvement and Continuing Education in Dental Practice. Journal of the American Dental Association 139: 656-659 [Full text]  
• Darden, P. M., Taylor, J. A., Brooks, D. A., Hendricks, J.W., Massoudi, M., Stevenson, J. M., Bocian, A. B. (2008). How Should Immunization Rates Be Measured in the Office Setting? A Study from PROS and NMA PedsNet. CLIN PEDIATR 47: 252-260 [Abstract]  
• Flores, A. I., Bilker, W. B., Alessandrini, E. A. (2008). Effects of Continuity of Care in Infancy on Receipt of Lead, Anemia, and Tuberculosis Screening. Pediatrics 121: e399-e406 [Abstract] [Full text]  
• Barlow, S. E., and the Expert Committee, (2007). Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics 120: S164-S192 [Abstract] [Full text]  
• Davis, M. M., Gance-Cleveland, B., Hassink, S., Johnson, R., Paradis, G., Resnicow, K. (2007). Recommendations for Prevention of Childhood Obesity. Pediatrics 120: S229-S253 [Abstract] [Full text]  
• Boom, J. A., Nelson, C. S., Laufman, L. E., Kohrt, A. E., Kozinetz, C. A. (2007). Improvement in Provider Immunization Knowledge and Behaviors Following a Peer Education Intervention. CLIN PEDIATR 46: 706-717 [Abstract]  
• Boonyasai, R. T., Windish, D. M., Chakraborti, C., Feldman, L. S., Rubin, H. R., Bass, E. B. (2007). Effectiveness of Teaching Quality Improvement to Clinicians: A Systematic Review. JAMA 298: 1023-1037 [Abstract] [Full text]  
• Epstein, J. N., Rabiner, D., Johnson, D. E., FitzGerald, D. P., Chrisman, A., Erkanli, A., Sullivan, K. K., March, J. S., Margolis, P., Norton, E. C., Conners, C. K. (2007). Improving Attention-Deficit/Hyperactivity Disorder Treatment Outcomes Through Use of a Collaborative Consultation Treatment Service by Community-Based Pediatricians: A Cluster Randomized Trial. Arch Pediatr Adolesc Med 161: 835-840 [Abstract] [Full text]  
• Mercier, C. E., Barry, S. E., Paul, K., Delaney, T. V., Horbar, J. D., Wasserman, R. C., Berry, P., Shaw, J. S. (2007). Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project. Pediatrics 120: 481-488 [Abstract] [Full text]  
• Zolotor, A. J., Randolph, G. D., Johnson, J. K., Wegner, S., Edwards, L., Powell, C., Esporas, M. H. (2007). Effectiveness of a Practice-Based, Multimodal Quality Improvement Intervention for Gastroenteritis Within a Medicaid Managed Care Network. Pediatrics 120: e644-e650 [Abstract] [Full text]  
• Todres, M., Stephenson, A., Jones, R. (2007). Medical education research remains the poor relation. BMJ 335: 333-335 [Full text]  
• Shaw, J. S., Wasserman, R. C., Barry, S., Delaney, T., Duncan, P., Davis, W., Berry, P. (2006). Statewide Quality Improvement Outreach Improves Preventive Services for Young Children. Pediatrics 118: e1039-e1047 [Abstract] [Full text]  
• Young, P. C., Glade, G. B., Stoddard, G. J., Norlin, C. (2006). Evaluation of a Learning Collaborative to Improve the Delivery of Preventive Services by Pediatric Practices. Pediatrics 117: 1469-1476 [Abstract] [Full text]  
• Willigendael, E. M, Teijink, J. A., Bartelink, M.-L., Langenberg, M., Welten, R. J., Buller, H. R, Prins, M. H (2005). Combined training of GPs and practice-assistants on peripheral arterial disease: positive effects after six months. Fam Pract 22: 520-522 [Abstract] [Full text]  
• Randolph, G., Fried, B., Loeding, L., Margolis, P., Lannon, C. (2005). Organizational Characteristics and Preventive Service Delivery in Private Practices: A Peek Inside the "Black Box" of Private Practices Caring for Children. Pediatrics 115: 1704-1711 [Abstract] [Full text]  
• Rosenthal, M. S., Lannon, C. M., Stuart, J. M., Brown, L., Miller, W. C., Margolis, P. A. (2005). A Randomized Trial of Practice-Based Education to Improve Delivery Systems for Anticipatory Guidance. Arch Pediatr Adolesc Med 159: 456-463 [Abstract] [Full text]  
• Roetzheim, R. G., Christman, L. K., Jacobsen, P. B., Schroeder, J., Abdulla, R., Hunter, S. (2005). Long-term Results From a Randomized Controlled Trial to Increase Cancer Screening Among Attendees of Community Health Centers. Ann Fam Med 3: 109-114 [Abstract] [Full text]  
• Lannon, C., Stark, A. R. (2004). Closing the Gap Between Guidelines and Practice: Ensuring Safe and Healthy Beginnings. Pediatrics 114: 494-496 [Full text]  
• (2004). Other articles noted: 06 Feb 2004 to 16 Apr 2004. Evid. Based Nurs. 7: e3-e3 [Full text]  
• Margolis, P. A. (2004). Small Steps and Big Leaps: Implications of the National Survey of Early Childhood Health for Improving the Quality of Preventive and Developmental Care for Young Children. Pediatrics 113: 1988-1990 [Full text]  
• (2004). Other articles noted. Evid. Based Med. 9: 95-96 [Full text]  

Rapid Responses:

Read all Rapid Responses

Improved delivery or improved documentation

Richard L Davies
bmj.com, 15 Feb 2004 [Full text]

Online poll

Find out more>>