Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study

Abstract

Purpose: Our purpose was to assess whether a practice's adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control.

Methods: We divided practices into quartiles of blood pressure control performance and considered the top quartile as the benchmark for comparison. Using abstracted clinical data from electronic health records, we performed a cross-sectional study to assess the association of top quartile hypertension control and (1) the baseline practice adaptive reserve (PAR) scores and (2) baseline practice leadership scores, using modified Poisson regression models adjusting for practice-level characteristics.

Results: Among 181 practices, 46 were in the top quartile, which averaged 68% or better blood pressure control. Practices with higher PAR scores compared with lower PAR scores were not more likely to reside in the top quartile of performance (prevalence ratio [PR] = 1.92 for highest quartile; 95% CI, 0.9-4.1). Similarly, high quality improvement leadership capability compared with lower capability did not predict better blood pressure control performance (PR = 0.94; 95% CI, 0.57-1.56). Practices with higher proportions of commercially insured patients were more likely than practices with lower proportions of commercially insured patients to have top quartile performance (37% vs 26%, P =.002), whereas lower proportions of the uninsured (8% vs 14%, P =.055) were associated with better performance.

Conclusions: Our findings show that adaptive reserve and leadership capability in quality improvement implementation are not statistically associated with achieving top quartile practice-level hypertension control at baseline in the Heart Health NOW project. Our findings, however, may be limited by a lack of patient-related factors and small sample size to preclude strong conclusions.

Keywords: blood pressure control; cardiovascular disease; hypertension; leadership; population health; primary health care; quality improvement.

Figure 1

Predicted practice-level performance on blood pressure control measure stratified by organizational quality improvement characteristics. KDIS = Key Drivers of Implementation Scale; PAR =practice adaptive reserve. Note: Unadjusted linear regression models were used to estimate predicted proportion of hypertension control. ^aPredicted mean practice-level adequate hypertension control calculated using linear regression models. ^bNo statistical difference between mean adequate hypertension control and higher leadership quality improvement capability (P =.321). ^cNo statistical difference between mean adequate hypertension control and higher quartiles of PAR (P =.504).