This application from the University of North Carolina at Chapel Hill. It proposes a four-year randomized trial to be conducted in 48 sites. The study has two primary hypotheses: 1) private pediatric practices implementing an """"""""office system for prevention"""""""" will have higher rates of four core preventive services (immunizations and screening for anemia, tuberculosis, and lead) than those which do not implement the system; and 2) practices implementing a greater number of office systems components will have larger increases in rates of preventive care than practices using fewer components. Outcome measures are the levels of immunizations and screening for anemia and lead in all infants one year of age. In secondary analysis, the investigators will assess: 1) the impact of the system on rates of preventive services among socially disadvantaged children; 2) to what extent practices provide counseling services more effectively (provision of a diet with adequate amounts of iron, use of a car seat, insuring adequate amounts of fluoride among infants over 6 months); 3) rates of vision and blood pressure screening in children four years of age; 4) the impact of the system on parents' knowledge and behavior regarding prevention; 5) impact on providers' documentation of preventive services; 6) what practice characteristics are associated with pre-intervention performance; 7) whether practices that implement an office system continue to use it after the end of the intervention; and 8) what the impact is on changes over time on: a. physician and staff knowledge about prevention systems b. activities used in providing services c. attitudes towards ease of providing preventive care.
