Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
J Gen Intern Med. 2020 Nov;35(11):3197-3204. doi: 10.1007/s11606-020-06094-5. Epub 2020 Aug 17.
Identifying characteristics of primary care practices that perform well on cardiovascular clinical quality measures (CQMs) may point to important practice improvement strategies.
To identify practice characteristics associated with high performance on four cardiovascular disease CQMs.
Longitudinal cohort study among 211 primary care practices in Colorado and New Mexico. Quarterly CQM reports were obtained from 178 (84.4%) practices. There was 100% response rate for baseline practice characteristics and implementation tracking surveys. Follow-up implementation tracking surveys were completed for 80.6% of practices.
Adult patients, staff, and clinicians in family medicine, general internal medicine, and mixed-specialty practices.
Practices received 9 months of practice facilitation and health information technology support, plus biannual collaborative learning sessions.
This study identified practice characteristics associated with overall highest performance using area under the curve (AUC) analysis on aspirin therapy, blood pressure management, and smoking cessation CQMs.
Among 178 practices, 39 were exemplars. Exemplars were more likely to be a Federally Qualified Health Center (69.2% vs 35.3%, p = 0.0006), have an underserved designation (69.2% vs 45.3%, p = 0.0083), and have higher percentage of patients with Medicaid (p < 0.0001). Exemplars reported greater use of cardiovascular disease registries (61.5% vs 29.5%,), standing orders (38.5 vs 22.3%) or electronic health record prompts (84.6% vs 49.6%) (all p < 0.05), were more likely to have medical home recognition (74.4% vs 43.2%, p = 0.0006), and reported greater implementation of building blocks of high-performing primary care: regular quality improvement team meetings (3.0 vs 2.2), patient experience survey (3.1 vs 2.2), and resources for patients to manage their health (3.0 vs 2.3). High improvers (n = 45) showed greater improvement implementing team-based care (32.8 vs 11.7, p = 0.0004) and population management (37.4 vs 20.5, p = 0.0057).
Multiple strategies-registries, prompts and protocols, patient self-management support, and patient-team partnership activities-were associated with delivering high-quality cardiovascular care over time, measured by CQMs.
ClinicalTrials.gov registration: NCT02515578.
识别在心血管临床质量指标（CQM）上表现出色的初级保健实践的特征，可能指向重要的实践改进策略。
确定与四项心血管疾病 CQM 表现出色相关的实践特征。
在科罗拉多州和新墨西哥州的 211 个初级保健实践中进行的纵向队列研究。从 178 个（84.4%）实践中获得了季度 CQM 报告。基线实践特征和实施跟踪调查的回复率为 100%。对 80.6%的实践进行了后续实施跟踪调查。
家庭医学、普通内科和混合专科实践中的成年患者、员工和临床医生。
实践接受了 9 个月的实践促进和健康信息技术支持，以及每半年一次的协作学习会议。
本研究使用曲线下面积（AUC）分析，确定了与阿司匹林治疗、血压管理和戒烟 CQM 整体表现最高相关的实践特征。
在 178 个实践中，有 39 个是典范。典范更有可能是联邦合格的健康中心（69.2%比 35.3%，p = 0.0006），有服务不足的指定（69.2%比 45.3%，p = 0.0083），并且有更多的医疗补助患者（p < 0.0001）。典范报告称，心血管疾病登记册的使用更多（61.5%比 29.5%），有常规订单（38.5%比 22.3%）或电子健康记录提示（84.6%比 49.6%）（均 p < 0.05），更有可能获得医疗之家认可（74.4%比 43.2%，p = 0.0006），并报告实施了高绩效初级保健的构建块：定期质量改进团队会议（3.0 比 2.2），患者体验调查（3.1 比 2.2），以及患者管理自身健康的资源（3.0 比 2.3）。高改进者（n = 45）在实施基于团队的护理方面表现出更大的改进（32.8%比 11.7%，p = 0.0004）和人群管理（37.4%比 20.5%，p = 0.0057）。
多种策略-登记册、提示和协议、患者自我管理支持以及患者与团队的合作活动-与通过 CQM 衡量的高质量心血管护理的持续提供有关。
ClinicalTrials.gov 注册：NCT02515578。
