Quality of Cardiovascular Disease Care in Small Urban Practices

Donna Shelley; Batel Blechter; Nina Siman; Nan Jiang; Charles Cleland; Gbenga Ogedegbe; Stephen Williams; Winfred Wu; Erin Rogers; Carolyn Berry

doi:10.1370/afm.2174

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Figure 1
Proportion of patients who meet the treatment target of the ABCS clinic guidelines among small, independent, primary care practices in New York City (N = 134).
ABC = aspirin use, blood pressure control, cholesterol management; ABCS = aspirin use, blood pressure control, cholesterol management, and smoking screening and counseling.

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Table 1

Characteristics of Small Independent Primary Care Practices (N=134)

Characteristic	Value
Practice
Clinicians
Solo clinician, No. (%)	93 (73.2)
≥2 Clinicians, No. (%)	34 (26.8)
Practice ownership
Independent, No. (%)	122 (91.7)
Other, No. (%)	11 (8.3)
ACO status
Part of ACO, No. (%)	57 (42.5)
Other, No. (%)	77 (57.5)
MUA designation^a
Yes, No. (%)	56 (41.8)
No, No. (%)	78 (58.2)
PCMH recognition
Yes, No. (%)	60 (44.8)
No, No. (%)	74 (55.2)
Full-time equivalent of supporting staff, mean (SD), No.	4.8 (5.9)
Patient panel size, mean (SD), No.	1,969.2 (2,264.6)
Patient
Non-Hispanic white patient, mean (SD), %	19.3 (26.8)
Medicaid payer, mean (SD), %	43.3 (27.5)
Organizational capacity
Adaptive reserve, mean (SD), No.	0.8 (0.2)
CPCQ^d, mean (SD), No.	0.8 (0.2)
Burnout of lead clinician, No. (%)
Yes	12 (11.4)
No	93 (88.6)

ACO = accountable care organization; CPCQ = Change Process Capability Questionnaire; MUA = medically underserved area; PCMH = patient-centered medical home.
Note: Among 134 small independent primary care practices, 113 reported full-time equivalent of supporting staff; 120 provided data about patient panel size and the percentage of white patients; 105 reported the percentage of Medicaid payers among their patients; and 112 completed data on adaptive reserve.
↵a Data extracted from Health Resources and Services Administration website.

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Table 2

Bivariate Analysis of the Factors Associated With the Outcomes of ABCS and Composite Measures

	Aspirin Use		Blood Pressure Control		Cholesterol Management		Smoking Screening and Counseling		ABC Composite

Characteristic	RR (95% CI)	P Value	RR (95% CI)	P Value	RR (95% CI)	P Value	RR (95% CI)	P Value	RR (95% CI)	P Value
Practice
Number of clinicians (solo)	1.17 (1.08–1.25)	.007	1.02 (0.96–1.09)	>.999	1.07 (0.98–1.14)	>.999	1.02 (0.93–1.10)	>.999	1.29 (1.12–1.47)	.011
Practice ownership (Independent)	0.99 (0.84–1.12)	>.999	0.96 (0.84–1.06)	>.999	0.98 (0.85–1.09)	>.999	1.03 (0.88–1.15)	>.999	0.92 (0.70–1.13)	>.999
ACO status (yes)	1.05 (0.97–1.12)	>.999	0.99 (0.93–1.05)	>.999	0.97 (0.90–1.04)	>.999	1.04 (0.96–1.11)	>.999	1.11 (0.97–1.26)	>.999
MUA designation^a (yes)	1.05 (0.97–1.12)	>.999	0.97 (0.91–1.03)	>.999	0.96 (0.89–1.03)	>.999	1.03 (0.95–1.10)	>.999	1.01 (0.88–1.15)	>.999
PCMH recognition (yes)	1.01 (0.93–1.08)	>.999	1.03 (0.97–1.09)	>.999	1.02 (0.95–1.09)	>.999	1.06 (0.98–1.13)	>.999	1.07 (0.93–1.21)	>.999
Full-time equivalent of supporting staff	1.01(0.95–1.06)	>.999	0.98 (0.94–1.02)	>.999	1.02 (0.97–1.06)	>.999	1.02 (0.96–1.07)	>.999	1.00 (0.92–1.08)	>.999
Patient panel size	0.99 (0.95–1.02)	>.999	0.98 (0.96–1.00)	>.999	0.99 (0.96–1.03)	>.999	1.02 (0.95–1.08)	>.999	0.96 (0.91–1.00)	.704
Patient
Non-Hispanic white patient	0.82 (0.66–0.97)	.145	1.13 (1.01–1.23)	.416	1.01 (0.88–1.12)	>.999	0.79 (0.61–0.95)	0.098	0.95 (.68–1.24)	>.999
Medicaid payer	1.08(0.90–1.21)	>.999	0.94 (0.81–1.06)	>.999	1.06 (0.90–1.19)	>.999	1.17 (1.01–1.28)	0.434	1.09 (0.80–1.38)	>.999
Organizational capacity
Adaptive reserve	0.81 (0.58–0.99)	.330	1.05 (0.86–1.20)	>.999	0.83 (0.62–1.00)	.588	0.90 (0.65–1.07)	>.999	0.87 (0.56–1.19)	>.999
CPCQ	0.90 (0.64–1.09)	>.999	1.13 (0.93–1.30)	>.999	0.89 (0.68–1.06)	>.999	1.21 (0.93–1.40	>.999	1.01 (0.66–1.37)	>.999
Burnout of lead clinician (yes)	1.05 (0.91–1.16)	>.999	1.04 (0.93–1.13)	>.999	1.04 (0.91–1.15)	>.999	1.07 (0.93–1.17)	>.999	1.13 (0.91–1.35)	>.999

ABC = aspirin use, blood pressure control, and cholesterol management; ABCS = aspirin use, blood pressure control, cholesterol management, smoking screening and counseling; ACO = accountable care organization; CPCQ = Change Process Capability Questionnaire; MUA = medically underserved area; PCMH = patient-centered medical home; RR = risk ratio.
Note: P values were adjusted for multiple testing using the Holm method.²⁴
↵a Data extracted from the Health Resources and Services Administration website.