Influence of Primary Care Practice and Provider Attributes on Preventive Service Delivery Dorothy Y. Hung, PhD, MA, MPH, Thomas G. Rundall, PhD, Benjamin F. Crabtree, PhD, Alfred F. Tallia, MD, MPH, Deborah J. Cohen, PhD, Helen A. Halpin, PhD Background: While visits to the doctor’s office are appropriate times to advise patients on health behaviors, these opportunities are often missed. Lapses in care quality are no longer attributed solely to individuals, but are also increasingly understood to be the result of organizational factors. This research examines the influence that both practice and provider attributes have on the delivery of preventive services for health behaviors. Methods: This study used data collected from the Prescription for Health initiative sponsored by the Robert Wood Johnson Foundation. Quantitative data on 52 primary care practices and 318 healthcare providers were gathered from September 2003 to September 2004, and were analyzed upon completion of data collection. Hierarchical linear modeling was used to examine associations between both practice and provider attributes and preventive service delivery. Results: Practice staff participation in decisions regarding quality improvement, practice change, and clinical operations positively influenced the effect of work relationships and negatively influenced the effect of practice size on service delivery. Nurse practitioners and allied health professionals reported more frequent delivery of services compared to physicians. Last, use of reminder systems and patient registries were positively associated with preventive service delivery. Conclusions: This study offers preliminary support for staff participation in practice decisions as a positive aspect of teamwork and collaboration. Findings also suggest leveraging nonphysi- cian clinical staff and organized clinical systems to improve the delivery of preventive services for health behaviors. (Am J Prev Med 2006;30(5):413– 422) © 2006 American Journal of Preventive Medicine Introduction C hanging lifestyle behaviors such as cigarette smoking, physical inactivity, unhealthy dietary practices, and excessive alcohol intake is be- lieved to have the greatest potential for decreasing morbidity and mortality. 1 Approximately 22% of adults in the United States smoke, 58% are over- weight or obese, 65% do not exercise, and 21% engage in risky alcohol use. 2 A recent study shows that in 2000, these four behavioral factors accounted for 39% of deaths in the United States. 3 Healthcare providers can improve patient health by delivering services outlined in the U.S. Preventive Services Task Force (USPSTF) guidelines. 4 These include health risk assessments, behavioral counsel- ing, and referral to community-based health promo- tion activities. Primary care practices are strategic venues for initiating such preventive services. 5 Yet while visits to the doctor’s office are appropriate times to advise patients on health behaviors, these opportunities are often missed. 6 –10 Lapses in care quality are no longer attributed solely to individuals, but are increasingly understood to be the result of organizational factors as well. 11,12 This study seeks to identify both practice and pro- vider attributes associated with the delivery of pre- ventive services for health behaviors. In particular, recent research indicates that organizational at- tributes such as staff participation in decision mak- ing 13–17 can influence performance. Because primary care practices are complex organizations, theories such as the contingency perspective on decision making 18 –20 are informative and suggest a need for more focused attention on the interactive effects of organizational attributes. Such theories propose that associations between organizational factors and per- From the Division of Health Policy and Management, School of Public Health, University of California-Berkeley (Hung, Rundall, Halpin), Berkeley, California; and Department of Family Medicine, University of Medicine and Dentistry of New Jersey, The Robert Wood Johnson Medical School (Crabtree, Tallia, Cohen), Somerset, New Jersey Address correspondence and reprint requests to: Dorothy Y. Hung, PhD, Columbia University, Mailman School of Public Health, 722 W. 168th Street, Suite 526B, New York NY 10032. E-mail: dh2237@columbia.edu. 413 Am J Prev Med 2006;30(5) 0749-3797/06/$–see front matter © 2006 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2005.12.012