Clinical Operations Variables are Associated With Blood Pressure Outcomes.
Med Care
; 53(6): 480-4, 2015 Jun.
Article
em En
| MEDLINE
| ID: mdl-25974844
ABSTRACT
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. RESEARCHDESIGN:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Hipertensão
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Med Care
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Marrocos