Adjusted Mean Difference in Change Process Capability Questionnaire Strategies Scores by Practice Characteristics Among 1,181 Small to Medium-Size Primary Care Practices
Characteristic | Multivariable Final Model R2= 22.4% Adjusted Mean Difference |
---|---|
Practice characteristics | |
Practice ownership (Ref: clinician-owned) | |
Hospital/health system | −3.32a |
FQHC, RHC, IHS, federalc | −1.49 |
Other, noned | 0.62 |
Missing | 0.96 |
Locatione [Ref: urban core] | |
Large town | 1.29 |
Rural area | 0.65 |
Suburban | −2.13 |
Medically underserved area classification (Ref: No) | |
Yes | −1.52 |
Missing | 1.46 |
External factors | |
Received external incentives in prior | |
12 mo (Ref: No) | |
Yes | 0.96 |
Missing | −1.43 |
Participation in other demonstration projectsf (Ref: No) | |
Yes | 1.24 |
Missing | 3.10 |
Part of an accountable care organization (Ref: No) | |
Yes | 2.74a |
Missing | 2.23 |
Internal factors | |
Major disruption(s) in prior 12 mog (Ref: no disruption) | |
1 major disruption | −0.22 |
>1 major disruption | −2.68b |
Missing | 0.33 |
Completely electronic EHR (Ref: No, part paper) | |
Yes | −3.59b |
Missing | −1.54 |
Produced quality report(s) in prior 6 mo (Ref: No) | |
Yes | 5.09a |
Missing | 2.96 |
Report CQMs at practice level (Ref: No) | |
Yes | 2.21 |
Missing | 5.09b |
Ability to create CQM reports from EHR (Ref: No ability) | |
In-house clinician or other staff | 2.26b |
Outside service/consultant | 0.76 |
Missing | 0.18 |
Routinely discuss clinical quality data (Ref: Never) | |
Infrequently | 1.87 |
Often | 5.56a |
Not available, solo practice | 4.40b |
Don’t know | 3.81b |
Missing | 4.21b |
Use of at least 1 registry (Ref: No) | |
Yes | 3.74a |
Missing | 2.22 |
Guidelines for CVD prevention or managementh (Ref: Not used or clinican agreement to use) | |
Included in EHR prompts or standing orders | 4.45a |
Missing | 0.41 |
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.