Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices.

BACKGROUND: Guidelines for managing and preventing chronic disease tend to be well-known. Yet, translation of this evidence into practice is inconsistent. We identify a combination of factors that are connected to guideline concordant delivery of evidence-informed chronic disease care in primary care. METHODS: Cross-sectional observational study; purposively selected 22 practices to vary on size, ownership and geographic location, using National Quality Forum metrics to ensure practices had a ≥ 70% quality level for at least 2 of the following: aspirin use in high-risk individuals, blood pressure control, cholesterol and diabetes management. Interviewed 2 professionals (eg, medical director, practice manager) per practice (n = 44) to understand staffing and clinical operations. Analyzed data using an iterative and inductive approach. RESULTS: Community Health Centers (CHCs) employed interdisciplinary clinical teams that included a variety of professionals as compared with hospital-health systems (HHS) and clinician-owned practices. Despite this difference, practice members consistently reported a number of functions that may be connected to clinical chronic care quality, including: having engaged leadership; a culture of teamwork; engaging in team-based care; using data to inform quality improvement; empaneling patients; and managing the care of patient panels, with a focus on continuity and comprehensiveness, as well as having a commitment to the community. CONCLUSIONS: There are mutable organizational attributes connected-guideline concordant chronic disease care in primary care. Research and policy reform are needed to promote and study how to achieve widespread adoption of these functions and organizational attributes that may be central to achieving equity and improving chronic disease prevention.

Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices.

BACKGROUND: Guidelines for managing and preventing chronic disease tend to be well-known. Yet, translation of this evidence into practice is inconsistent. We identify a combination of factors that are connected to guideline concordant delivery of evidence-informed chronic disease care in primary care. METHODS: Cross-sectional observational study; purposively selected 22 practices to vary on size, ownership and geographic location, using National Quality Forum metrics to ensure practices had a ≥ 70% quality level for at least 2 of the following: aspirin use in high-risk individuals, blood pressure control, cholesterol and diabetes management. Interviewed 2 professionals (eg, medical director, practice manager) per practice (n = 44) to understand staffing and clinical operations. Analyzed data using an iterative and inductive approach. RESULTS: Community Health Centers (CHCs) employed interdisciplinary clinical teams that included a variety of professionals as compared with hospital-health systems (HHS) and clinician-owned practices. Despite this difference, practice members consistently reported a number of functions that may be connected to clinical chronic care quality, including: having engaged leadership; a culture of teamwork; engaging in team-based care; using data to inform quality improvement; empaneling patients; and managing the care of patient panels, with a focus on continuity and comprehensiveness, as well as having a commitment to the community. CONCLUSIONS: There are mutable organizational attributes connected-guideline concordant chronic disease care in primary care. Research and policy reform are needed to promote and study how to achieve widespread adoption of these functions and organizational attributes that may be central to achieving equity and improving chronic disease prevention.

Nutrition-related knowledge, attitudes, and dietary behaviors among head start teachers in Texas: a cross-sectional study.

Head Start teachers are responsible for providing nutrition education to over 1 million low-income children annually, yet little is known about their nutrition-related knowledge, attitudes, and behaviors. The purpose of this study is to assess the self-reported nutrition knowledge, attitudes, and behaviors among Head Start teachers from one urban Head Start organization in Harris County, TX. A cross-sectional, descriptive analysis was conducted using baseline surveys in the 2008-2009 school year. One hundred eighty-one Head Start teachers completed self-reported surveys of their nutrition knowledge, attitudes, behaviors, weight status, and other weight-related behaviors. The sample was predominantly female (97%) and minority (93%); 24% were overweight and 55% were obese. One fourth of the sample did not consume fruit (26%) or vegetables (23%) the previous day. Half of the teachers reported consuming french fries (52%) and soda (44%), and one fourth consumed fried meat (28%) at least once on the previous day. Only four teachers (3%) answered at least four of the five nutrition knowledge questions correctly. Half of the teachers (54%) agreed that it was hard to know which nutrition information to believe, and only 9% reported that their nutrition habits were healthy. A majority of teachers were trying to lose weight (71%) and said they would like to weigh less (81%). This study underscores the importance of providing nutrition education and wellness opportunities to Head Start teachers to better enable them to teach nutrition education to their students and to improve their own health.