Development of a model quality-of-care assessment program for adult preventive care in rural medical practices

A four-year project of quality-of-care assessment for 37 practices in rural North Carolina used chart abstraction and formal feedback to practitioners to improve compliance standards for 13 adult health maintenance interventions. In 1987, performance of Papanicolaou (Pap) test within two years ranged from 20% to 100% (mean, 61%), mammogram 0% to 70% (mean, 20%), and influenza vaccination 0% to 90% (mean, 59%). Practices received individual results and remediation took place for those practices that performed poorly; a reaudit took place in 1989, with improvement in all measures for all practices, except the influenza vaccination. Compliance results for 1989 were 30% to 100% (mean, 67%) for the Pap test, 10% to 100% (mean, 40%) for the mammography screening, and 5% to 80% for the influenza vaccination. These results suggest that coordinated quality-of-care assessment for rural practices can be performed with a modest administrative burden and substantial benefit to the practices.