Prevention in a kit: Guides, charts track care

Physician handbook gives counseling tips

When the U.S. Public Health Service in Washington, DC, developed the Put Prevention Into Practice program in 1994, its flow sheets, clinician and patient guides, and chart stickers were geared toward national preventive health goals.

Today, the program has another noteworthy benefit: it helps managed care organizations and physician groups improve their Health Plan Employer Data and Information Set (HEDIS) scores.

"HEDIS really has put preventive care on the map," says Lynn Soban, MPH, RN, director of Put Prevention Into Practice.

The Put Prevention Into Practice program is essentially a reminder and education system. The clinician’s handbook provides research-based information on 60 topics for children, adolescents, adults, and older adults. It states recommendations from medical associations and other authorities, lists resources and references, and provides risk factor tables.

The handbook even provides suggestions of how to phrase questions or provide advice. For example, clinicians are advised to ask about smoking "at every opportunity," to personalize the quit-smoking message to the patient’s health and family history, and to assist the patient in choosing a quit date.

By following those recommendations, physicians would score well on the HEDIS measure of "counseling to quit smoking." A flow sheet helps physicians keep track of risk factors, counseling, screening, and follow-up. (For sample flow sheet, see special supplement, inserted in this issue.)

"By developing a system that assures you do at least annual preventive services for every patient, you can’t help but improve your [HEDIS] scores," says Crystal Wilkinson, MSN, RN, CNS, adult health program specialist with the Texas Department of Health in Austin and a consultant who helps clinics and group practices implement the prevention program.

The Put Prevention Into Practice Program also includes "personal health guides" that physicians can give patients, explaining the preventive measures they need at various intervals, such as mammograms or cholesterol screening.

At family practice residency clinics in Corpus Christi, TX, a patient education coordinator reviews charts before patients arrive for their visits. The coordinator makes sure a risk assessment has been filled out within the past two years, and a flow chart is up-to-date. If the patient needs a screening test, a bright pink alert sticker is attached to the chart.

The coordinator also clips patient education material to the chart — based on risk factors circled on the flow sheet — which the physician can then discuss with the patient.

"It makes everybody think about patient education and preventive medicine every time they see a patient," says Kathleen Soch, MD, associate professor of medicine with the Corpus Christi family practice residency program at Spohn Memorial Hospital.

In an era when physicians are expected to do more in less time, the forms "tell you exactly what you need to do for your patients," Soch says.

Organizational tips included

One evaluation of the Put Prevention Into Practice program indicated that some group practices needed to make organizational changes before they could use the assessment and intervention materials effectively.1

Responding to that need, program administrators added a chapter to the clinician handbook to address "a systematic approach to adding preventive services."

With prevention-driven outcomes measures such as HEDIS, physicians also have greater motivation than they once did to reorient their practices, notes Soban. "As more incentives for delivering clinical preventive services are created, there will be more adoption of these materials," predicts Soban.


1. McVea K, et al. An ounce of prevention? Evaluation of the Put Prevention into Practice program. J Fam Pract 1996; 43:361-369.

For more information on Put Prevention Into Practice, contact:

Lynn Soban, Director, Room 738 G, Humphrey Building, 200 Independence Ave., S.W., Washington, DC 20201. Telephone: (202) 260-2325. Fax: (202) 205-9478. E-mail: LSoban@

To order Put Prevention Into Practice materials ($57 including shipping and handling), contact: Superintendent of Documents, U.S. Government Printing Office, P.O. Box 371954, Pittsburgh, PA 15250-7954. Telephone: (202) 512-0132. Fax: (202) 512-2250.

For more information about the Health Risk Appraisal ($195, including handbooks, software, and membership in the Healthier People Network), contact:

Edwin Hutchins, President, Healthier People Network, 1549 Clairmont Road, Suite 205, Decatur, GA 30033. Telephone: (404) 636-3127. Fax: (404) 636-0105.

For more information about the Texas Department of Health risk assessment and Put Prevention Into Practice program, contact:

Crystal Wilkinson, Specialist, Adult Health Program, Texas Department of Health, 1100 W. 49th St., Austin, TX 78756-3199. Telephone: (512) 458-7534. Fax: (512) 458-7254.

Internet Resources: Patients can conduct a risk assessment and receive a detailed analysis of how they can lower their health risks on this Web site sponsored by Greenstone Healthcare Solutions, a Kalamazoo, MI-based disease management consulting firm and a subsidiary of Pharmacia & Upjohn pharmaceutical firm. Put Prevention Into Practice materials are available and can be downloaded free of charge from this Web site.