Clinical Operations Variables are Associated With Blood Pressure Outcomes
Department of Quantitative Health Sciences
Cardiovascular Diseases | Health and Medical Administration | Health Services Administration
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 < 0.01) than the lowest quintile]. Practice appointment volume negatively affected the likelihood of normalization [episodes starting in months with the most appointments were associated with a 6 percentage point reduction in the probability of normalization (P=0.01)]. Neither clinician appointment volume nor practice clinician staffing levels were significantly associated with the probability of normalization.
CONCLUSIONS: Findings suggest that clinical operations factors can affect clinical outcomes like BP normalization, and point to the importance of considering outcome effects when organizing clinical care.
Rights and Permissions
Citation: Med Care. 2015 Jun;53(6):480-4. doi: 10.1097/MLR.0000000000000349. Link to article on publisher's site
Kressin, Nancy R.; Lasser, Karen E.; Paasche-Orlow, Michael K.; Allison, Jeroan J.; Ash, Arlene S.; Adams, William G.; Shanahan, Christopher; Legler, Aaron; and Pizer, Steven D., "Clinical Operations Variables are Associated With Blood Pressure Outcomes" (2015). University of Massachusetts Medical School Faculty Publications. 984.