Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study

Abstract

PURPOSE Our purpose was to assess whether a practice's adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control. METHODSWe divided practices into quartiles of blood pressure control performance and considered the top quartile as the benchmark for comparison. Using abstracted clinical data from electronic health records, we performed a crosssectional study to assess the association of top quartile hypertension control and (1) the baseline practice adaptive reserve (PAR) scores and (2) baseline practice leadership scores, using modified Poisson regression models adjusting for practice-level characteristics.RESULTS Among 181 practices, 46 were in the top quartile, which averaged 68% or better blood pressure control. Practices with higher PAR scores compared with lower PAR scores were not more likely to reside in the top quartile of performance (prevalence ratio [PR] = 1.92 for highest quartile; 95% CI, 0.9-4.1). Similarly, high quality improvement leadership capability compared with lower capability did not predict better blood pressure control performance (PR = 0.94; 95% CI, 0.57-1.56). Practices with higher proportions of commercially insured patients were more likely than practices with lower proportions of commercially insured patients to have top quartile performance (37% vs 26%, P = .002), whereas lower proportions of the uninsured (8% vs 14%, P = .055) were associated with better performance.CONCLUSIONS Our findings show that adaptive reserve and leadership capability in quality improvement implementation are not statistically associated with achieving top quartile practice-level hypertension control at baseline in the Heart Health NOW project. Our findings, however, may be limited by a lack of patientrelated factors and small sample size to preclude strong conclusions.

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“…The KDIS measurement instrument was developed by experts in primary care quality improvement to guide and capture implementation efforts within primary care practices and has not been subjected to the rigorous validation processes. However, the KDIS is used in a multiple NC AHEC projects and analyses where we continue to understand its value as an implementation effectiveness measurement tool [ 24 – 26 , 44 ]. The TE outcome measure and the KDIS Leadership measures were scored by each practice’s facilitator, thus there is a potential for same source bias.…”

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“…For example, although adaptive reserve for change is unquestionably important, in and of itself it may not be able to overcome other structural barriers to catalyzing practice performance improvement. 4 Staff and clinicians appear to perceive practice adaptive reserve for change in different ways across even the same work environment. 5 Clearly, segmenting an approach to reducing burnout and maintaining appetite and aptitude for change are necessary.…”

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“…PFs receive specialty training to help clinic teams work through complex change processes; they help practices overcome quality improvement barriers, such as fear of change, lack of knowledge, or misperceptions about the value added by implementing a change [ 5 ]. Their standardized approaches help address key issues such as establishing clear goals, demonstrating the potential for improvement, providing regular feedback, and trialing changes on a small-scale—all important factors related to securing and maintaining staff motivation and commitment to quality improvement initiatives [ 6 , 7 ].…”