Direct observation of rates of preventive service delivery in community family practice

Kurt C. Stange, Susan A. Flocke, Meredith A. Goodwin, Robert B. Kelly, Stephen J. Zyzanski

Research output: Contribution to journalArticlepeer-review

148 Scopus citations


Background. Data on preventive service delivery in primary care practice have been limited by indirect methods of measurement. This study describes directly observed rates of preventive service delivery during outpatient visits to community family physicians. Methods. In a multimethod cross-sectional study, research nurses directly observed consecutive patient visits in the offices of 138 family physicians in Northeast Ohio. Patient eligibility for services recommended by the U.S. Preventive Services Task Force was determined from medical record review. Service delivery was assessed by direct observation of outpatient visits. Rates of delivery of specific preventive services were computed. Global summary measures were calculated for health habit counseling, screening, and immunization services. Results. Among 4,049 visits by established patients with available medical records, wide variation was observed among rates of different preventive services delivered during well-care visits. During illness visits, rates were uniformly low for all preventive services. Counseling services were delivered at only slightly lower rates during illness visits compared to well visits. Patients were up to date on 55% of screening, 24% of immunization, and 9% of health habit counseling services. Conclusion. Rates of preventive service delivery are low. Illness visits are important opportunities to deliver preventive services, particularly health habit counseling, to patients. Preventive service delivery summary scores are useful in providing a patient population perspective on the delivery of preventive services and in focusing attention on delivery of a comprehensive portfolio of services. (C) 2000 American Health Foundation and Academic Press.

Original languageEnglish (US)
Pages (from-to)167-176
Number of pages10
JournalPreventive medicine
Issue number2 I
StatePublished - 2000
Externally publishedYes


  • Cancer prevention and control
  • Clinical preventive services
  • Family practice
  • Primary care

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Direct observation of rates of preventive service delivery in community family practice'. Together they form a unique fingerprint.

Cite this