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Delivering clinical preventive services is a systems problem

  • Mini-Series: Prevention of Cardiovascular Disease
  • Published:
Annals of Behavioral Medicine

Abstract

A steadily increasing number of research trials and prevention advocates are identifying the practice environment as the main source of both problems and solutions to the improved delivery of clinical preventive services. Although these sources are correctly focusing on office systems as solutions, there is a tendency to focus on only parts of a system and to relate this to just one or a few related preventive services.

However, the effort required to set up and maintain an office system makes it difficult to justify doing so for a single clinical activity. The process and system thinking of Continuous Quality Improvement (CQI) theory suggests that there may be both efficiency and effectiveness advantages to the concept of all clinical preventive services being served by a single system with many interrelated component processes. Such a system should be usable for all age groups. This system and its literature base are described. The feasibility of applying this concept is being tested in a randomized controlled trial in 44 primary care clinics in Minnesota and Wisconsin.

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Authors and Affiliations

  1. Group Health Foundation, 8100 34 Avenue South, P.O. Box 1309, 55440, Minneapolis, MN

    Leif I. Solberg, Carolyn A. Calomeni & Kathleen S. Conboy

  2. Mayo Clinic and Foundation, Rochester, USA

    Thomas E. Kottke

  3. Blue Plus, Minnesota, USA

    Shirley A. Conn

  4. Brekke Associates, Golden Valley, USA

    Milo L. Brekke

Authors
  1. Leif I. Solberg
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  2. Thomas E. Kottke
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  3. Shirley A. Conn
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  4. Milo L. Brekke
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  5. Carolyn A. Calomeni
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  6. Kathleen S. Conboy
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Additional information

Health Partners

Preparation of this manuscript was funded in part by the Agency for Health Care Policy and Research Grant R01 HS 08091.

We are grateful for the experience with the development and implementation of the processes described in this article that has been provided by working with 24 clinics in the IMPROVE Project over the past two years. This includes the two demonstration clinics for the study, Health Partners St. Paul Clinic and Kasson Mayo Family Practice Clinic, as well as the following intervention group clinics: Apple Valley Medical Center, Aspen Medical Group-W. St. Paul, Aspen Medical Group-W. Suburban, Chanhassen Medical Center, Chisago Medical Center, Creekside Family Practice, Douglas Drive Family Physicians, Eagle Medical, Fridley Medical Center, Hastings Family Practice, Hopkins Family Practice, Interstate Medical Center, Metropolitan Internists, Mork Clinic-Anoka, North St. Paul Medical Center, Ramsey Clinic-Amery, Ramsey Clinic-Baldwin, River Valley Clinic-Farmington, River Valley Clinic-Northfield, Southdale Family Practice, Stillwater Clinic, United Family Medical Center.

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Solberg, L.I., Kottke, T.E., Conn, S.A. et al. Delivering clinical preventive services is a systems problem. ann. behav. med. 19, 271–278 (1997). https://doi.org/10.1007/BF02892291

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