Division of Cardiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
Division of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Ann Fam Med. 2018 Apr;16(Suppl 1):S29-S34. doi: 10.1370/afm.2210.
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.
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.
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%, =.002), whereas lower proportions of the uninsured (8% vs 14%, =.055) were associated with better performance.
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.
我们旨在评估实践中的适应性储备和高质量改进领导力是否与人群血压控制有关。
我们将实践分为血压控制绩效的四分位数，并将最高四分位数作为比较的基准。使用电子健康记录中的临床数据摘要，我们进行了一项横断面研究，以评估高血压控制的前四分位数与（1）基线实践适应性储备（PAR）评分和（2）基线实践领导能力评分之间的关联，使用调整实践水平特征的修正泊松回归模型。
在 181 个实践中，46 个实践处于前四分位数，平均血压控制率为 68%或更高。与 PAR 得分较低的实践相比，PAR 得分较高的实践不太可能位于表现的前四分位数（最高四分位数的患病率比[PR] = 1.92；95%置信区间，0.9-4.1）。同样，与较低的能力相比，高质量改进领导力能力并不能预测更好的血压控制表现（PR = 0.94；95%置信区间，0.57-1.56）。与 PAR 得分较低的实践相比，商业保险患者比例较高的实践更有可能表现出前四分位数的表现（37%比 26%，.002），而未参保患者比例较低（8%比 14%，.055）与更好的表现相关。
我们的研究结果表明，适应性储备和质量改进实施的领导力能力与 Heart Health NOW 项目中基线时达到实践前四分位数高血压控制水平没有统计学关联。然而，由于缺乏与患者相关的因素和样本量小，我们的研究结果可能受到限制，无法得出强有力的结论。
