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Primary Care

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

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.38009.706319.47 (Published 12 February 2004) Cite this as: BMJ 2004;328:388
  1. Peter A Margolis (Peter_Margolis{at}med.unc.edu), professor of pediatrics and epidemiology1,
  2. Carole M Lannon, associate professor of pediatrics and internal medicine1,
  3. Jayne M Stuart, assistant professor of pediatrics1,
  4. Bruce J Fried, associate professor of health policy and administration2,
  5. Lynette Keyes-Elstein, assistant director of biostatistics3,
  6. Jr Donald E Moore, director, division of continuing medical education4
  1. 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. 2 University of North Carolina at Chapel Hill, School of Public Health, Department of Health Policy and Administration, Chapel Hill
  3. 3 Rho Inc, Chapel Hill, NC 27514, USA
  4. 4 Vanderbilt University School of Medicine, Nashville, TN 37232, USA
  1. Correspondence to: P A Margolis

    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.

    Footnotes

    • Contributors PAM, CML, JMS, BJF, LK-E conceived and designed the study. PAM, CML, JMS acquired data; PAM, CML, BJF, LK-E analysed and interpreted data. PAM, CML, LK-E, JMS, BJF, DEM drafted and revised the manuscript. LK-E provided statistical expertise; PAM, CML obtained funding; JMS, CML, PAM supervised the study. PAM is guarantor.

    • Funding US Agency for Healthcare Research and Quality (RO1-HS08509), US Bureau of Maternal and Child Health (RO1-HS08509), the North Carolina Division of Medical Assistance, the North Carolina Area Health Education Centers, and the Robert Wood Johnson Foundation Generalist Faculty Scholars Program.

    • Competing interests None declared.

    • Ethical approval University of North Carolina at Chapel Hill ethics committee.

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