• Douglas H Fernald, Rebecca Mullen, Tristen Hall, Andrew Bienstock, Stephanie Kirchner, Kyle Knierim, Dionisia de la Cerda, Danelle Callan, Robert L Rhyne, L Miriam Dickinson, and W Perry Dickinson.
• Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. doug.fernald@cuanschutz.edu.
• J Gen Intern Med. 2020 Nov 1; 35 (11): 3197-3204.

BackgroundIdentifying characteristics of primary care practices that perform well on cardiovascular clinical quality measures (CQMs) may point to important practice improvement strategies.ObjectiveTo identify practice characteristics associated with high performance on four cardiovascular disease CQMs.DesignLongitudinal 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.ParticipantsAdult patients, staff, and clinicians in family medicine, general internal medicine, and mixed-specialty practices.InterventionPractices received 9 months of practice facilitation and health information technology support, plus biannual collaborative learning sessions.Main MeasuresThis 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.ResultsAmong 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).ConclusionsMultiple 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.Trial RegistrationClinicalTrials.gov registration: NCT02515578.

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