Putting prevention in its place: the shift from clinic to community

Despite widespread insurance coverage for adult vaccinations, cancer screening, and cardiovascular disease prevention measures, most U.S. adults are not up to date with these routine services. This paper reports the efforts of Sickness Prevention Achieved through Regional Collaboration (SPARC), a New England-based organization working to broaden delivery of preventive measures throughout its communities. SPARC's model regards the physician practice as only one element of a network of coordinated prevention activities. SPARC began with the conceptualization of a policy challenge, designed and evaluated interventions to address that problem, and is now influencing public health policies to expand the delivery of clinical preventive services.