A steadily increasing number of research trials and prevention advocates are identifying the practice environment as the main source of both problems and solutions to the improved delivery of ...clinical preventive services. Although these sources are correctly focusing on office systems as solutions, there is a tendency to focus on only parts of a system and to relate this to just one or a few related preventive services. However, the effort required to set up and maintain an office system makes it difficult to justify doing so for a single clinical activity. The process and system thinking of Continuous Quality Improvement (CQI) theory suggests that there may be both efficiency and effectiveness advantages to the concept of all clinical preventive services being served by a single system with many interrelated component processes. Such a system should be usable for all age groups. This system and its literature base are described. The feasibility of applying this concept is being tested in a randomized controlled trial in 44 primary care clinics in Minnesota and Wisconsin.
Although most physicians believe that smoking cessation assistance is important for their patients, the majority of smokers report that they have not received smoking cessation advice from a ...physician. We therefore tested whether on-site recruitment, training, and organizational assistance in incorporating a smoking intervention system of documented efficacy into nonvolunteer primary care practices would result in higher rates of smoking cessation advice to patients.
This was a nonrandomized trial comparing all 10 primary care clinics in an intervention area to all 8 primary care clinics from a geographically separate control area. The evaluation was based on the smoking intervention activities of each of the clinics as reported on preintervention and postintervention mail surveys of cohorts of regular smokers seen in the clinics.
Preintervention, 22.9% +/- 11.2% of the intervention clinic cohort and 21.9% +/- 9.6% (P = .84) of the control clinic cohort reported that they had been asked about tobacco during a clinic visit in the prior 6 months. Postintervention, the intervention clinic cohort was significantly more likely to report that someone had asked them if they smoked (39.8% +/- 12.3% vs 26.0% +/- 12.2%; P less than .05), that their physician asked them to quit if they were currently smoking (40.5% +/- 12.1% vs 26.4% +/- 14.6%; P less than .05), and that someone had commended them if they had recently quit smoking (28.2% +/- 19.8 vs 11.3% +/- 11.8%; P less than .05).
The intervention significantly increased the rates at which a population of primary care clinics identified their patients who smoked, advised them to quit smoking, and commended those who had recently quit smoking.
Full assessment of soil carbon (C) and nitrogen (N) pools is necessary for long-term sustainability of agricultural production and provides information on plant health and nutrient cycling. A major ...component of nutrient cycling is plant root C and N. Although root C and N contribute to nutrient cycling, determination of these quantities is laborious and tedious and is, therefore, not commonly done. In this study we attempt to determine the feasibility of using remotely sensed canopy reflectance as a proxy to determine root C and N data of live, standing forages. The study site was the United States Department of Agriculture-Grazinglands Research Laboratory located in El Reno, Oklahoma. Twelve plots in each of two sites (a native, tallgrass prairie and an improved, Old World Bluestem pasture) were used for collection and measurement of root C and root N and measurement of canopy reflectance using a field portable hyperspectral spectroradiometer. Root and soil samples were then taken from under the remote sensed area for total C and N analysis using the combustion method. The results of this study indicated that it is feasible to predict root C and N, but further study is required to improve model accuracy.
Background. There is increasing evidence that the most effective way to improve delivery of preventive services in primary care is to establish organized preventive service systems. This study tests ...the hypothesis that a managed care organization (MCO) can help its contracted private primary care clinics to develop such systems.
Methods. Forty-four primary care clinics contracting with two large MCOs were randomized to a comparison (C) or an intervention (I) group. Group (I) clinic team leaders received training plus ongoing consultation and networking. Personnel at all 44 clinics completed surveys prior to and at the end of the intervention to measure adoption of the improvement process and the prevention system.
Results. All 22 (I) clinics identified teams that appeared to follow the seven-step improvement process. The mean numbers of system processes were identical at baseline, 11.2 (I) vs 12.1 (C), while after the intervention this had changed to 25.8 in (I) clinics vs 11.3 in (C) (P= 0.022).
Conclusions. With training and assistance, interested primary care clinic teams will establish functioning CQI teams that will produce a substantial increase in the presence of functional prevention system processes. Whether this change is sufficient to increase the rates of preventive services remains to be documented.
Sixty-six physicians were randomized to three groups to conduct a 1-month campaign to help their patients stop smoking. The workshop group received free patient education materials and a 6-hour ...training workshop. The materials group received free patient education materials, and the no-assistance group received nothing. A telephone interview was completed with 89% of the 6767 eligible adult patients seen during the month of the campaign. The brief training program and patient education materials marginally increased the smoking intervention activities of volunteer physicians in private practice. Both workshop and materials physicians asked 54% of their smoking patients to stop; no-assistance physicians asked 40%. One year later, 36% of patients who had not even been asked by their doctors if they smoked reported that they had tried to stop smoking. If the physician had asked the patient if he or she smoked, the probability of a quit attempt was 47%. Patients who had been asked if they smoked were more likely to claim to have stopped (13%) than patients who had not been asked (9%). However, the proportion of patients claiming continued abstinence (range, 12% to 14%) was not related to the group of the physician.
Patient satisfaction has become a measure of the quality of health care, and in highly competitive markets like the Twin Cities metropolitan area of Minnesota, it has become a health plan marketing ...tool. The purpose of this analysis is to examine whether the known association between preventive services and patient satisfaction might spontaneously lead clinicians to recommend preventive services at greater rates.
We conducted a mail survey of a stratified random sample (n = 6,830) of adult patients who had recently visited a physician in one of 44 clinics in and around Minneapolis-St. Paul, Minnesota. The main outcome measures are patient-reported rates of being advised to have eight preventive services, patient satisfaction with preventive services, patient satisfaction with overall health care, and correlations among these variables.
Self-reports of being advised to have a preventive service when due were correlated with higher levels of satisfaction with that specific service only at levels of r = 0.16 to r = 0.35. They were correlated at levels of r = 0.01 to r = 0.27 with the Group Health Association of America satisfaction index.
Although there is a positive association between being advised to have a preventive service on the one hand and reporting satisfaction with care on the other, this association appears too weak to spontaneously stimulate physicians to recommend preventive services to their patients. This suggests that, if preventive services are to be delivered at higher rates, they must become an explicit component of quality evaluations.
This paper describes the first version of a stand-alone runoff routing tool, mizuRoute. The mizuRoute tool post-processes runoff outputs from any distributed hydrologic model or land surface model to ...produce spatially distributed streamflow at various spatial scales from headwater basins to continental-wide river systems. The tool can utilize both traditional grid-based river network and vector-based river network data. Both types of river network include river segment lines and the associated drainage basin polygons, but the vector-based river network can represent finer-scale river lines than the grid-based network. Streamflow estimates at any desired location in the river network can be easily extracted from the output of mizuRoute. The routing process is simulated as two separate steps. First, hillslope routing is performed with a gamma-distribution-based unit-hydrograph to transport runoff from a hillslope to a catchment outlet. The second step is river channel routing, which is performed with one of two routing scheme options: (1) a kinematic wave tracking (KWT) routing procedure; and (2) an impulse response function – unit-hydrograph (IRF-UH) routing procedure. The mizuRoute tool also includes scripts (python, NetCDF operators) to pre-process spatial river network data. This paper demonstrates mizuRoute's capabilities to produce spatially distributed streamflow simulations based on river networks from the United States Geological Survey (USGS) Geospatial Fabric (GF) data set in which over 54 000 river segments and their contributing areas are mapped across the contiguous United States (CONUS). A brief analysis of model parameter sensitivity is also provided. The mizuRoute tool can assist model-based water resources assessments including studies of the impacts of climate change on streamflow.
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