Preventive services (immunizations, screening tests, prophylaxis, and counseling) are a vital but too often neglected aspect of primary care. Studies of “actual” causes of death have found that half of all deaths in the United States are attributable to preventable causes, such as tobacco use, improper nutrition, and lack of physical activity, injuries, and infections. Healthy People 2010 delineated 10 leading “health indicators”, most of which can be addressed by preventive services in the clinical or community setting. Despite their effectiveness, preventive services are often delivered inconsistently and unequally. Evaluation of Healthy People 2000 objectives found that low-income persons, and minority groups, such as African-Americans, and Hispanics, received substantially fewer preventive services than the general U.S. population. A large body of scientific literature exists on successful interventions to improve clinical preventive service delivery. However, even the most basic interventions may not be used in practice. One of biggest challenges facing primary care is the implementation of evidence-based interventions that assure that preventive care is delivered consistently and effectively in the practice setting.
Please be advised that many of the materials created for the Prevention Collaborative are considered works-in-progress and may undergo further revisions. The work to-date is shared here for health centers wishing to move forward in this area and for others with interest in this ongoing work. It is not required that health centers undertake this body of work. However, recognizing that the goal of each health center in the Health Disparities Collaboratives is to scale up efforts to reach all of their patients, regardless of diagnosis, this information should prove useful if prevention is a content area of interest to your organization.
PREVENTION COLLABORATIVE RESOURCES:
- Working Measures:
- These measures have evolved over the past 3 years and have been tracked by the Prevention Pilot teams.
- Charter:
- Provides background regarding the importance of preventive services;
- Communicates
the problem statement;
- Describes the process of how the Prevention Pilot began
- Change Concepts for Prevention:
- Provides
change ideas in each component of the Care Model that, if successfully
implemented into care delivery systems, should result in improvements in
care.
- This
grid has been developed and refined from the repeated testing of the
change ideas by the Prevention Pilot teams. As they
currently stand, the majority of these change ideas have shown themselves
to be high leverage, meaning that the implementation of the idea has
resulted in improvement.
PREVENTION COLLABORATIVE: HISTORY AND PARTICIPANTS
The aim of the Prevention Collaborative is to develop and refine interventions based upon the Care Model that will reduce the gap between actual and desired delivery rates for preventive services across the life span in community-based health centers. Measures include the global measure of self management goal setting in addition to 5 “index” measures relating to cardiovascular health, healthy lifestyle, oral health, immunizations, and cancer screening. Each of the index measures represents an aggregate for 2-4 specific measures relating to each topic. The participating organizations developed key change concepts and ideas and built toolkits to assist others in their endeavors with prevention.
The Prevention Pilot began in November 2002, when five health centers (representing the diversity of HRSA/BPHC supported health centers) attended the Pilot Learning Session #1. These five teams were chosen from an existing pool of high-performers who had made significant strides in a previous Collaborative. Three organizations remained fully engaged in the process for a 24 month period, subsequently participating in a harvesting session to identify key change concepts and ideas as well as key lessons learned in November of 2004. The remaining two teams were unable to sustain ongoing active participation due to significant organizational upheaval and stresses, but reengaged to participate in refinement of the change package. The challenge was to identify effective processes of care that would lead to improvements in preventive services. The three preventive health issues (healthy weight, oral health, and tobacco cessation) and four preventive service issues (immunizations, childhood lead screening, cholesterol screening, and blood pressure screening) were included in the key elements of the Pilot in year one. This represents an emphasis on preventive health issues and services across the entire age span of ambulatory primary care users in community-based health centers. Cancer screening and perinatal issues were not included initially due to their inclusion in other HDC work, but cancer screening has subsequently been added.
KEY PARTNERS
Date Created: July 7 , 2006
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