• Stephan Lindner, Leif I Solberg, William L Miller, Bijal A Balasubramanian, Miguel Marino, K John McConnell, Samuel T Edwards, Kurt C Stange, Rachel J Springer, and Deborah J Cohen.
• From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS). lindners@ohsu.edu.
• J Am Board Fam Med. 2019 May 1; 32 (3): 398-407.

PurposeWe assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices.MethodsThis cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by the Agency for Health Care Research and Quality. We compared physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHC) by using 15 survey-based practice characteristic measures, 9 survey-based quality improvement process measures, and 4 electronic health record-based cardiovascular disease prevention quality measures, namely, aspirin prescription, blood pressure control, cholesterol management, and smoking cessation support (ABCS).ResultsPhysician-owned practices were more likely to be solo (45.0% compared with 8.1%, P < .001 for health system practices and 12.8%, P = .009 for FQHCs) and less likely to have experienced a major change (eg, moved to a new location) in the last year (43.1% vs 65.4%, P = .01 and 72.1%, P = .001, respectively). FQHCs reported the highest use of quality improvement processes, followed by health system practices. ABCS performance was similar across ownership type, with the exception of smoking cessation support (51.0% for physician-owned practices vs 67.3%, P = .004 for health system practices and 69.3%, P = .004 for FQHCs).ConclusionsPrimary care practice ownership was associated with differences in quality improvement process measures, with FQHCs reporting the highest use of such quality-improvement strategies. ABCS were mostly unrelated to ownership, suggesting a complex path between quality improvement strategies and outcomes.© Copyright 2019 by the American Board of Family Medicine.

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