Introduction
Cardiovascular disease preventive services (aspirin use, blood pressure control, and
smoking-cessation support) are crucial to controlling cardiovascular diseases. This
study draws from 1,248 small-to-medium-sized primary care practices participating
in the EvidenceNOW Initiative from 2015-2016 across 12 states to provide practice-level
aspirin use, blood pressure control, and smoking-cessation support estimates; report
the percentage of practices that meet Million Hearts targets; and identify the practice
characteristics associated with better performance.
Methods
This cross-sectional study utilized linear regression modeling (analyzed in 2020–2021)
to examine the association of aspirin use, blood pressure control, and smoking-cessation
support performance with practice characteristics that included structural attributes
(e.g., size, ownership, rurality), practice capacity and contextual characteristics,
health information technology, and patient panel demographics.
Results
On average, practice performance on aspirin use, blood pressure control, and smoking-cessation
support quality measures was 64% for aspirin, 63% for blood pressure, and 62% for
smoking-cessation support. The 2012 Million Hearts goal of achieving the rates of
70% was achieved by 52% (aspirin), 32% (blood pressure), and 54% (smoking) of practices.
Practice characteristics associated with aspirin use, blood pressure control, and
smoking-cessation support performance included ownership (hospital/health system–owned
practices had 11% higher aspirin performance than clinician-owned practices [p=0.001]), rurality (rural practices had lower performance than urban practices in
all aspirin use, blood pressure control, and smoking-cessation support quality metrics
[difference in aspirin=11.1%, p=0.001; blood pressure=4.2%, p=0.022; smoking=14.4%, p=0.009]), and disruptions (practices that experienced >1 major disruption showed lower
aspirin performance [−7.1%, p<0.001]).
Conclusions
Achieving the Million Hearts targets may be assisted by collecting and reporting practice-level
performance, which can promote change at the practice level and identify areas where
additional support is needed to achieve initiative goals.
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Article Info
Publication History
Published online: December 19, 2021
Identification
Copyright
© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.