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PEDIATRICS Vol. 106 No. 4 Supplement October 2000, pp. 879-885

QUALITY ASSESSMENT AND IMPROVEMENT:
Measuring the Process of Preventive Service Delivery in Primary Care Practices for Children

Received Jul 13, 1999; accepted May 1, 2000.

Kathleen L. Gest*, Peter MargolisDagger , W. Clayton BordleyDagger , and Jayne StuartDagger

From the * Lincoln Community Health Center, Durham, North Carolina; and Dagger  Children's Primary Care Research Group, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

Background.  Children may fall behind on preventive services because they do not receive needed services at the time of an office visit (a missed opportunity). However, methods are needed to measure problems in the care delivery process that lead to missed opportunities. We developed a method to examine the key steps in the preventive service delivery process and identify problems; we assessed the feasibility and validity of the method in primary care practices for children.

Methods.  Using 3 data collection methods, we measured key steps in the process of preventive service delivery in primary care offices: a chart audit was used to measure each child's preventive service status before and after an office visit, a brief parent exit interview was used to assess preventive service delivery not documented in the chart, and a staff checklist was used to assess the role of nursing and other office staff. The feasibility of using this combination of measures to identify problems in the care delivery process was evaluated in 3 representative primary care practices (2 pediatric, 1 family practice) among children 5 years and younger.

Results.  The measurement method was implemented in all 3 practices. The validity of the method was supported by its ability to detect differences among practices in the proportion of children eligible for immunizations and screening tests and in the proportion of children undergoing key steps in the process of preventive service delivery. The practice with the lowest proportion of children whose charts were screened for preventive services needs had the lowest performance of preventive services.

Conclusions.  It is possible to assess specific elements in the process of preventive service delivery in primary care practices. Use of this approach may help practices design and monitor interventions to improve the quality of preventive care delivery.  Key words:  primary care, children, preventive services, quality improvement, measurement.




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