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.
METHODS We 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.
RESULTS The 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.
Footnotes
Conflicts of interest: authors report none.
Funding support: This project was supported by the Agency for Healthcare Research and Quality (AHRQ) through contract No. HHSA29020120009I, and grant No. R18 HS023922.
Disclaimer: This work represents the opinions of the authors and should not be interpreted as official positions of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
Previous presentation: This study was presented in part at the New York State Population Health Summit; December 12, 2016; New York, New York.
Supplementary materials: Available at http://www.AnnFamMed.org/content/16/Suppl_1/S21/suppl/DC1/.
- Received for publication June 13, 2017.
- Revision received October 6, 2017.
- Accepted for publication October 11, 2017.
- © 2018 Annals of Family Medicine, Inc.