Format

Send to

Choose Destination
Ann Fam Med. 2018 Apr;16(Suppl 1):S29-S34. doi: 10.1370/afm.2210.

Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study.

Author information

1
Division of Cardiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina kamal.henderson@unchealth.unc.edu.
2
Division of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
3
Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
4
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.
5
Departments of Global Health and Biostatistics, University of Washington, Seattle, Washington.
6
UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.

Abstract

PURPOSE:

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.

METHODS:

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.

RESULTS:

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%, P =.002), whereas lower proportions of the uninsured (8% vs 14%, P =.055) were associated with better performance.

CONCLUSIONS:

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.

KEYWORDS:

blood pressure control; cardiovascular disease; hypertension; leadership; population health; primary health care; quality improvement

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center