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The Article in Brief
Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context
Deborah J. Cohen, and colleagues
Background In order to make meaningful gains in cardiovascular disease care, primary care medical practices should adopt a set of care improvements specific to their practice size and type. High blood pressure and smoking are among the biggest risk factors associated with cardiovascular disease. Primary care physicians help patients manage high blood pressure and provide smoking cessation interventions. Researchers collected qualitative data from a subset of participating EvidenceNOW primary care practices to answer the following research question: In the context of an initiative focused on improving cardiovascular disease preventive care, what factors and operational changes were linked to improvements in smoking and blood pressure outcomes?
What This Study Found Researchers found that there is no one central playbook for all types of practices, but they did identify combinations of practice characteristics, amount of practice facilitation, and operational changes linked with improved cardiovascular disease care. Smaller, solo and clinician-owned practices that changed routine aspects of their process, such as training medical assistants to perform accurate blood pressure readings; allowing staff to take repeated blood pressure measures and note second readings in electronic medical records; and equipping clinicians with the tools to perform smoking screening and cessation referrals, were able to make substantial improvements.
In addition, working with a practice facilitator helped. Smaller practices that participated in a moderate amount of facilitation were able to make these improvements. However, for larger hospital or health system–owned practices and Federally Qualified Health Centers more facilitation was necessary.Implications
- Researchers conclude: “making operational changes alone—in certain clinical settings—was insufficient to achieve meaningful improvements.” In practices that are part of larger, more complex systems, external facilitation along with prioritization of operational changes may be critical to successful quality improvement.
Supplemental Appendixes, Tables & Figures
Supplemental Appendixes, Tables, & Figures