Facilitators of Transforming Primary Care: A Look Under the Hood at Practice Leadership

Article Figures & Data

Table 1

Practice Characteristics

Characteristic	All Practices (N=76)	Interviewed Practices (n=12)
Quality focus, No. (%)
Diabetes	51 (67)	7 (58)
Asthma	25 (33)	5 (42)
Service area, No. (%)
Rural	37 (49)	6 (50)
Urban	39 (51)	6 (50)
Clinicians, No. (%)
≤3	18 (24)	5 (42)
4–6	26 (34)	2 (17)
≥7	32 (41)	5 (42)
Practice specialty, No. (%)
Family medicine	42 (55)	7 (58)
Pediatric medicine	20 (26)	4 (33)
Internal medicine	10 (13)	1 (8)
Mixed	4 (5)	0 (0)
Practice type, academic, No. (%)	6 (8)	2 (17)
Insurance
Medicaid, median %	20	30
Uninsured, median %	4	8
Affiliated with CCNC Medicaid Network, No. (%)	65 (85)	12 (100)
Practice visits per day, median No.	60	43
Use of EHR, No. (%)	38 (50)	9 (75)
PCMH recognition by NCQA, No. (%)
Have recognition	22 (29)	6 (50)
Actively working on recognition	17 (23)	4 (34)
Improved in first year: diabetes measures, No. (%)
Hemoglobin A_1c <9%	25 (50)	–
LDL cholesterol <100 mg/dL	23 (55)	–
Blood pressure <130/80 mm Hg	33 (73)	–
Annual eye examination	35 (78)	–
Nephropathy screening	34 (77)	–
Improved in first year: asthma measures, No. (%)
Severity assessed	17 (68)	–
Annual influenza vaccine	19 (76)	–
Bundled measure (assessed, influenza vaccine, controller medication use)	16 (70)	–

CCNC = Community Care of North Carolina; EHR = electronic health record; LDL = low-density lipoprotein; NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home.
Note: For the All Practices column, the number of practices having data was fewer than 76 for the measures of Medicaid insurance (n = 67), uninsured (n = 68), and practice visits per day (n = 64).

Table 2

Association of Higher Leadership With the Proportion of Patients Within a Practice Achieving Various Clinical Measures

Model	Nephropathy Screening	Yearly Eye Examination	LDL Cholesterol <100 mg/dL	Blood Pressure <130/80 mm Hg	Hemoglobin A_1c <9%
Model 1
Leadership	1.51 (1.20–1.90)	1.13 (0.93–1.37)	1.02 (0.87–1.20)	1.07 (0.91–1.26)	1.07 (0.92–1.25)
Leadership	<.001	.23	.77	.43	.39
Model 2
Leadership (adjusted for engagement)	1.37 (1.08–1.74)	1.04 (0.86–1.25)	1.06 (0.91–1.23)	1.10 (0.94–1.28)	1.08 (0.93–1.26)
Leadership (adjusted for engagement)	.01	.68	.48	.25	.31
Engagement (adjusted for leadership)	1.26 (1.06–1.51)	1.21 (1.02–1.43)	0.93 (0.82–1.05)	0.94 (0.80–1.11)	0.97 (0.77–1.23)
Engagement (adjusted for leadership)	.01	.03	.25	.49	.83

LDL=low-density lipoprotein cholesterol.
Note: Values are odds ratios (95% CIs) and P values. Values were adjusted for time.

Table 3

Association of Higher Leadership With Practice Levels of Implementation of Various Tools

Model	Registry	Templates for Planned Care	Protocols	Self-Management Support
Model 1
Leadership	1.92 (1.07–3.42)	6.78 (4.02–11.44)	5.23 (2.99–9.14)	3.66 (2.26–5.91)
Leadership	.03	<.0001	<.0001	<.0001
Model 2
Leadership (adjusted for engagement)	1.24 (0.66–2.34)	4.20 (2.44–7.23)	3.53 (1.99–6.25)	2.41 (1.54–3.79)
Leadership (adjusted for engagement)	.50	<.001	<.001	<.0001
Engagement (adjusted for leadership)	2.50 (1.41–4.42)	3.30 (1.87–5.82)	2.81 (1.66–4.77)	2.80 (1.74–4.50)
Engagement (adjusted for leadership)	.002	<.001	<.001	<.001

Note: Values are odds ratios (95% CIs) and P values. Values were adjusted for time.