Table 3

Adjusted Mean Difference in Change Process Capability Questionnaire Strategies Scores by Practice Characteristics Among 1,181 Small to Medium-Size Primary Care Practices

CharacteristicMultivariable 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, noned0.62
Locatione [Ref: urban core]
 Large town1.29
 Rural area0.65
Medically underserved area classification (Ref: No)
External factors
Received external incentives in prior
 12 mo (Ref: No)
Participation in other demonstration projectsf (Ref: No)
Part of an accountable care organization (Ref: No)
Internal factors
Major disruption(s) in prior 12 mog (Ref: no disruption)
 1 major disruption−0.22
 >1 major disruption−2.68b
Completely electronic EHR (Ref: No, part paper)
Produced quality report(s) in prior 6 mo (Ref: No)
Report CQMs at practice level (Ref: No)
Ability to create CQM reports from EHR (Ref: No ability)
 In-house clinician or other staff2.26b
 Outside service/consultant0.76
Routinely discuss clinical quality data (Ref: Never)
 Not available, solo practice4.40b
 Don’t know3.81b
Use of at least 1 registry (Ref: No)
Guidelines for CVD prevention or managementh (Ref: Not used or clinican agreement to use)
 Included in EHR prompts or standing orders4.45a
  • 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.