Strategies for Improving the Quality of Preventive Services in Primary Care

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DESCRIPTION (provided by the applicant): Tobacco use, risky drinking, poor diet, and physical inactivity are risk factors for many chronic diseases, and are currently the nation's leading causes of preventable death and disability. According to the U.S. preventive Services Task Force, among the most effective interventions for reducing disease and disability are those that address patients' personal health habits. While primary care practices are well-positioned to improve patient health, these opportunities are often missed. The purpose of this research is to examine how these opportunities can be enhanced using strategies for quality improvement in primary care settings. This research is motivated by my career goals of conducting rigorous research that informs change at the practice, provider, and patient levels to improve care delivery processes and health outcomes. The current proposal is aligned with a national research agenda to improve healthcare quality by improving delivery structures and processes at multiple levels of the healthcare system. In this proposal, I will pursue the following aims: 1) evaluate the Chronic Care Model as a system redesign strategy to improve preventive care processes and patient outcomes such as health risk behaviors and quality of life; 2) examine pay for performance as a financial strategy to improve the quality of prevention-oriented practice structures, care processes, and patient outcomes; 3) assess the impact of teamwork and staff participation in decision making as management strategies for quality initiatives in prevention; 4) evaluate the external validity of a national initiative to improve the quality of behavioral interventions, and describe facilitators and barriers to participating in this practice-based research; 5) conduct a sustainability study of projects and recommend strategies for maintaining proven interventions in clinical practice, i.e., for translating research into practice. The proposed research will empirically examine conceptual models that have been recommended for improving healthcare structures, processes, and outcomes. Planned studies will leverage both cross sectional and longitudinal data gathered from a national initiative funding AHRQ practice-based research networks to develop behavior change interventions in real-world primary care practices. Mixed methodology will be used, including new qualitative research techniques and advanced quantitative methods that will be acquired as a result of the proposed career development plan.