Organizational factors influence the quality of preventive care. Combining facility-level data from a national organizational survey and centrally available, externally abstracted chart review data on prevention performance, we assessed the relationship between structural features of primary care departments and the quality of preventive care delivered. Primary care practice resources were significantly and positively associated with the delivery of 6 of 9 preventive services. Adjusting for facility size and academic affiliation, these resource arrangements accounted for substantial variation in 8 of 9 services. Assuring high-quality prevention performance requires ongoing investment in primary care–based infrastructure.
VA Health Services Research & Development (HSR&D) Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, Calif (Drs Soban and Yano); and the Department of Health Services, UCLA School of Public Health, Los Angeles, Calif (Dr Yano).
Corresponding author: Lynn M. Soban, PhD, MPH, RN, VA Health Services Research & Development (HSR&D) Center of Excellence, VA Greater Los Angeles Healthcare System, 16111 Plummer St (Mailcode 152), Sepulveda, CA 91343 (e-mail: Lsoban@ucla.edu).
This work was funded by VA HSR&D Service Quality Enhancement Research Initiative (QUERI) and the National Cancer Institute through a service-directed research project (Project No. CRS 02-163). Dr Soban is funded by a VA Office of Academic Affiliations associated health postdoctoral fellowship. We also acknowledge the VA Office of Quality and Performance for providing access to centralized VA prevention data through an approved data use agreement and as a result are indebted to Steven Wright, PhD, Mike Kerr, and Dean Bross for their input and consultation throughout this project. We also thank Andy Lanto and Ismelda Canelo from the VA Greater Los Angeles HSR&D Center of Excellence for their support on behalf of this study. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.