“…• Reminders directed to providers or patients (Brimberry 1988;Lar son et al 1979;Larson et al 1982;Vallez et al 1985;Thompson et al 1986;McDowell, Newell, andRosser 1986, 1989;Mullooly 1987;Leininger et al 1996) • Delegation of activities (Frame, Kowulich, and Llewellyn 1984) • Administrative rules (McGowan and Finland 1974;Durbin, Lapidas, and Goldmann 1981;Vayda and Mindell 1982;Ruchlin, Finkel, and McCarthy 1982;M artin et al 1982;Gryskiewicz and Detmer 1983;W ong, McCarron, and Shaw 1983) • Presence of local com munity standards or norms (Pineault 1976;Zelnio 1982;Dorsey 1983;Hartzema and Christensen 1983;Ep stein, Begg, and McNeil 1983;W illiams and Williams 1987) • Flow sheets, checklists, brief scripts as primary care "tools," or guidelines (Cohen et al 1982;Prislin, Vandenbark, and Clarkson 1986;Madlon-Kay 1987;Cheney and Ramsdel 1987;Shank, Pow ell, and Llewelyn 1989;D ietrich et al 1992;Johns et al 1992;Britt et al 1994) • Exam room posters (Lane, Polednak, and Burg 1991;Savage 1991) • Stickers affixed to charts identifying patient's health risks. The concept of smoking status as a vital sign is one example (Cohen et al 1987(Cohen et al , 1989Solberg et al 1990 (Lerman et al 1992)…”