Quality of Cardiovascular Disease Care in Small Urban Practices

Abstract

PURPOSE We wanted to describe small, independent primary care practices' performance in meeting the Million Hearts ABCSs (aspirin use, blood pressure control, cholesterol management, and smoking screening and counseling), as well as on a composite measure that captured the extent to which multiple clinical targets are achieved for patients with a history of arteriosclerotic cardiovascular disease (ASCVD). We also explored relationships between practice characteristics and ABCS measures. METHODSWe conducted a cross-sectional, bivariate analysis using baseline data from 134 practices in New York City. ABCS data were extracted from practices' electronic health records and aggregated to the site level. Practice characteristics were obtained from surveys of clinicians and staff at each practice. RESULTSThe proportion of at-risk patients meeting clinical goals for each of the ABCS measures was 73.0% for aspirin use, 69.6% for blood pressure, 66.7% for cholesterol management, and 74.2% screened for smoking and counseled. For patients with a history of ASCVD, only 49% were meeting all ABC (aspirin use, blood pressure control, cholesterol management) targets (ie, composite measure). Solo practices were more likely to meet clinical guidelines for aspirin (risk ratio [RR ] = 1.17, P = .007) and composite (RR = 1.29, P = .011) than practices with multiple clinicians.CONCLUSION Achieving targets for ABCS measures varied considerably across practices; however, small practices were meeting or exceeding Million Hearts goals (ie, 70% or greater). Practices were less likely to meet consistently clinical targets that apply to patients with a history of ASCVD risk factors. Greater emphasis is needed on providing support for small practices to address the complexity of managing patients with multiple risk factors for primary and secondary ASCVD. INTRODUCTIONC ardiovascular disease remains the number 1 cause of death in the United States.1 One-half of the US adult population has 1 or more preventable risk factors for arteriosclerotic cardiovascular disease (ASCVD), but less than one-half are meeting all of their clinical goals. 2Increasing the adoption of effective clinical preventive services that reduce ASCVD mortality, including treating hypertension and hyperlipidemia, would result in large improvements in population health. 3HealthyHearts New York City, 1 of 7 research cooperatives funded through the EvidenceNOW initiative, is studying the effectiveness of external practice facilitation to increase capacity among small, independent primary care practices to implement innovations in health care aimed at increasing adoption of the Million Hearts ABCS (aspirin use, blood pressure control, cholesterol management, and smoking cessation) guidelines.1,4 These guidelines include aspirin when indicated, blood pressure control, cholesterol management through guideline-recommended use of lipid-lowering medications, and both screening for tobacco use and offering smokers cessation interventions or counseling. S22There is a strong ...

Clinician Perspectives on the Benefits of Practice Facilitation for Small Primary Care Practices

“…We used a purposeful sampling approach to identify and recruit interviewees to obtain diversity on 3 criteria: study wave, geographic region (the 5 New York City boroughs), and baseline ABCS performance (high, medium, or low) using a composite measure created for the study that assessed the proportion of patients in a practice with a history of atherosclerotic cardiovascular disease who met targets for 3 of the 4 Million Hearts outcomes (ABC, defined as receiving aspirin and statin therapy, and having their blood pressure controlled to <140/90 mm Hg). 12,17 A member of the study team invited clinicians to participate in an interview via an institutional e-mail, with up to 3 telephone or in-person follow-up e-mails for nonresponders. Figure 1 provides an overview of the recruitment process.…”

A practice facilitation-guided intervention in primary care settings to reduce cardiovascular disease risk: A cost analysis

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Assessing Quality Improvement Capacity in Primary Care Practices

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