Related Experiment Video
Updated: Aug 4, 2026
E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Failure of a continuous quality improvement intervention to increase the delivery of preventive services. A
L I Solberg1, T E Kottke, M L Brekke
1HealthPartners Research Foundation, Minneapolis, Minn., USA. leif.i.solberg@healthpartners.com
Context:
Although there has been enormous interest in continuous quality improvement (CQI) as a measure to improve health care, this enthusiasm is based largely on its apparent success in business rather than formal evaluations in health care.
Objective:
To determine whether a managed care organization can increase delivery of eight clinical preventive services by using CQI.
Design:
Primary care clinics were randomly assigned to improve delivery of preventive services with CQI (intervention group) or to provide usual care (control group).
Intervention:
Through leadership support, training, consulting, and networking, each intervention clinic was assisted to use CQI multidisciplinary teams to develop and implement systems for delivery of preventive services.
Setting:
44 primary care clinics in greater Minneapolis-St. Paul.
Patients:
Patients 19 years of age and older completed surveys at baseline (n = 6830) and at follow-up (n = 6431). Medical chart audits were completed on 4777 patients at baseline and 4546 patients at follow-up.
Main Outcome Measures:
The proportion of patients who were up-to-date (according to chart audit) and the proportion of patients who were offered a service if not up-to-date (according to patient report) for 8 preventive services.
Results:
Compared with the control group, based on the proportion of patients who were up-to-date, use of only one preventive service--pneumococcal vaccine--increased significantly in the intervention group (17.2% absolute increase from baseline to follow-up compared with a 0.3% absolute increase in the control group, P = 0.003). Similarly, based on patient report of being offered a service if not up-to-date, delivery of only one preventive service--cholesterol testing--significantly increased in the intervention group compared with the control group (4.6% increase vs. 0.4% absolute decrease in the control group; P = 0.006).
Conclusion:
In this trial, CQI methods did not result in clinically important increases in preventive service delivery rates.
Related Concept Videos
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:30Preventive Healthcare Services
01:26Levels of Health Promotion and Illness Prevention
In primary prevention, actions taken before disease onset prevent the disease from...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:03Nursing Interventions I: Taxonomy of Nursing Interventions
A nursing intervention is a treatment or action based on scientific concepts and knowledge from the nursing, behavioral, and physical sciences. Identifying and prioritizing nursing interventions based on the desired outcome is...
01:11Blinding