Using continuous quality improvement to increase preventive services in clinical practice - Going beyond guidelines

Leif I. Solberg, Thomas E. Kottke, Milo L. Brekke, Carolyn A. Calomeni, Shirley A. Conn, Gestur Davidson

Research output: Contribution to journalArticlepeer-review

62 Scopus citations


Background. Even the most uniformly accepted prevention guidelines do not by themselves lead to implementation or to adequate rates of preventive services in medical practice. Although much has been learned about the office systems that seem to be needed for major change in a busy clinical practice, there are still no examples of a model for developing, implementing, and sustaining those office systems in a nonacademic practice. Methods. IMPROVE, the first large randomized controlled trial of CQI (continuous quality improvement) in any industry, is providing a scientific test of the hypothesis that HMO sponsorship of a CQI-based intervention can lead to sustained organizational change, implementation and maintenance of office systems, and improved rates of adult preventive services in contracted private primary care clinics. The 22 clinics assigned to the intervention arm of the study are receiving training, consultation, networking, and reinforcement for internal multidisciplinary teams as they work through a structured process to understand and improve their clinic's process for providing preventive services. Rates and quality of eight preventive services in these clinics are being compared over time with those in 22 matched comparison clinics. Results. The 44 clinics needed for the trial have been recruited and randomized, and baseline comparisons show no significant differences between the two groups. Nine months into the trial, 21 of 22 intervention clinics have completed training and are pursuing a systematic improvement process for preventive services. Conclusions. With external training and consultation, many private primary care clinics will voluntarily engage in a lengthy multidisciplinary team effort to use CQI techniques to study and systematically improve their entire process for providing preventive services.

Original languageEnglish (US)
Pages (from-to)259-267
Number of pages9
JournalPreventive medicine
Issue number3
StatePublished - May 1996

Bibliographical note

Funding Information:
We gratefully acknowledge the support of the sponsoring HMOs (Blue Plus and HealthPartners), Group Health Foundation, and the IMPROVE project staff. However, much of whatever success this project achieves will be the result of the voluntary efforts of the participating clinics and their staffs: HealthPartners St. Paul Clinic, Kasson Mayo Family Practice Clinic, Aspen Medical Group– Bloomington, East Main Physicians, East Side Medical Center, Family Medical Center–Hennepin County, Forest Lake Doctors Clinic, Hudson Physicians, North Clinic, Northport Medical Center, Palen Heights Medical Center, Ramsey Clinic–Osceola, Ramsey Family Physicians, Richfield Medical Group, River Valley–Cottage Grove, River Valley–Hastings, River Valley–Woodbury, River Valley Medical Center–St. Croix Falls, Silver Lake Clinic, Southdale Internal Medicine, Southwest Clinic, St. Croix Valley Clinic, Sundance Medical Center, Valley Family Practice, 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, and United Family Medical Center.

Funding Information:
1This project was supported by Grant RO1 HS08091 from the Agency for Health Care Policy and Research.


  • CQI
  • Preventive services
  • managed care
  • quality improvement


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