The case of the missing clinical preventive services systems.

OBJECTIVE: To examine the presence and comprehensiveness of organized processes and systems in a sample of primary care clinics shown to have high variation in rates of providing preventive services. DESIGN: Survey study. SETTING: 44 primary care clinics recruited for a scientific trial of a quality improvement intervention to improve preventive services. PARTICIPANTS: 647 clinicians and nurses. MEASUREMENTS: The presence of 10 organized prevention processes for eight adult preventive services as reported by those clinicians and nurses on a detailed written survey. RESULTS: In more than 50% of clinics, 7 of the 10 prevention processes were reported to be absent for all eight services. Only the follow-up process was commonly present; this was also the only process that was usually present for most applicable services. CONCLUSIONS: The paucity of recognizable organized processes to support the systematic delivery of adult preventive services in clinics with highly varying rates of providing these services supports the idea that lack of systems may be an important source of the variability and low rates. Most of the existing processes are fragmented and do not function across multiple preventive services.