Clinical Operations Variables are Associated With Blood Pressure Outcomes

• Published in: Medical care 2015-06, Vol.53 (6), p.480-484
• Main Authors: Kressin, Nancy R., Lasser, Karen E., Paasche-Orlow, Michael, Allison, Jeroan, Ash, Arlene S., Adams, William G., Shanahan, Christopher W., Legler, Aaron, Pizer, Steven D.
• Format: Article
• Language: English
• Subjects: Aged; Appointments and Schedules; Blood Pressure; Brief Report; Clinical medicine; Cohort Studies; Comorbidity; Female; Humans; Hypertension; Hypertension - therapy; Male; Medical diagnosis; Medical treatment; Middle Aged; Personnel Staffing and Scheduling - statistics & numerical data; Primary Health Care - organization & administration; Primary Health Care - statistics & numerical data
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0000000000000349

BACKGROUND:Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes. OBJECTIVES:To assess clinical operations factors’ effects on normalization of uncontrolled BP. RESEARCH DESIGN:Observational cohort study. SUBJECTS:Patients diagnosed with hypertension from a large urban clinical practice (2005–2009). MEASURES:We obtained clinical data on BP, organized by person-month, and administrative data on primary care provider (PCP) staffing. We assessed the resolution of an episode of uncontrolled BP as a function of time-varying covariates including practice-level appointment volume, individual clinicians’ appointment volume, overall practice-level PCP staffing, and number of unique PCPs. RESULTS:Among the 7409 unique patients representing 50,403 person-months, normalization was less likely for the patients in whom the episode starts during months when the number of unique PCPs were high [the top quintile of unique PCPs was associated with a 9 percentage point lower probability of normalization (P