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.
METHODS We 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 cross-sectional 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 patient-related factors and small sample size to preclude strong conclusions.
- blood pressure control
- quality improvement
- primary health care
- hypertension
- leadership
- population health
- cardiovascular disease
Footnotes
Conflicts of interest: authors report none.
Funding support: Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ) through contract No. HHSA290201200019I, and grant No. R18 HS023912.
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.
- Received for publication June 19, 2017.
- Revision received January 21, 2018.
- Accepted for publication January 24, 2018.
- © 2018 Annals of Family Medicine, Inc.