Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

AIC=Akaike Information Criterion; CQM=Clinical Quality Measure; CVD=cardiovascular disease; EHR = electronic health record; FQHC = federally qualified health center, IHS = Indian health services clinics; Ref = reference; RHC = rural health clinic; VA = Veterans Affairs.

Note: Final multivariable model was selected using backward model selection by the AIC. The model with the lowest AIC was preferred regardless of statistical significance for individual covariates.

↵a P value <.001.

↵b P value <.05.

↵c Includes FQHCs, RHCs, IHS, and VA, military, Department of Defense or other federally owned practices.

↵d Includes practices with nonfederal, private/nonclinician, academic, or tribal ownership, those indicating “other” without specifying an ownership type, and practices responding “no” to every ownership type.

↵e Location categories determined using rural-urban commuting area (RUCA) codes.

↵f Other demonstrations programs include State Innovation Models initiative, Comprehensive Primary Care Initiative, Transforming Clinical Practice Initiative, community health worker training program, Blue Cross Blue Shield Patient-Centered Medical Home program, and Million Hearts.

↵g Major disruptions include new EHR, new billing system, moved locations, staff turnover, and purchased/affiliated with larger organization.

↵h Guidelines for CVD prevention and management were combined to avoid multicollinearity. A practice was categorized as “Included in EHR prompts or standing orders” if they denoted that in either CVD prevention or CVD management or both.