Estimating the Cardiovascular Disease Risk Reduction of a Quality Improvement Initiative in Primary Care: Findings from EvidenceNOW

Article Figures & Data

Table 1.

Sample Characteristics

Patient characteristics (percent)
Female	56.5
White	59.4
Black	15.5
Hispanic	19.5
Age 40 to 59	57.3
Age 60 to 75	39.0
Age 76 to 79	3.6
Patient population groups (percent)
	49.8
	33.9
	1.6
	2.8
	4.2
	7.8
Number of patients
NHANES sample	1295
EN patient population	3,961,384

Notes: The table shows characteristics of the NHANES sample. Weights are used for all patient characteristics and patient population group values. The number of EvidenceNOW patients corresponding to the NHANES sample is based on calculations using number of clinicians and number of patients per clinicans (see Appendix for details).
Abbreviations: EN = EvidenceNOW; = people in the denominator only requiring smoking intervention; = people in the denominator for cholesterol management and smoking intervention; = people in the denominator for blood pressure control and smoking intervention; = people in the denominator for aspirin prescription, cholesterol management and smoking intervention; = people in the denominator for blood pressure control, cholesterol management and smoking intervention; G_ABCS = people in the denominator for aspirin prescription, blood pressure control, cholesterol management and smoking intervention.

Table 2.

Average ASCVD Risk and ASCVD Risk Reductions Due to Improvements in the ABCS

Average	Improvement in clinical outcomes
ASCVD	All ABCS	Aspirin Only	Blood Pressure Only	Cholesterol Only	Smoking Only
Baseline	10.11	10.11	10.11	10.11	10.11
All practices
Post-intervention	10.03	10.10	10.08	10.08	10.10
Absolute change (p-value)	−0.08 (P < .001)	−0.01 (P > .05)	−0.03 (P > .05)	−0.03 (P > .05)	−0.01 (P > .05)
Relative change	−0.79	−0.14	−0.30	−0.28	−0.07
Practices with median or higher improvement
Post-intervention	9.79	10.06	9.93	10.04	10.09
Absolute change	−0.32 (P < .001)	−0.05 (P > .05)	−0.18 (P > .05)	−0.08 (P > .05)	−0.02 (P > .05)
Relative change	−3.28	−0.53	−1.79	−0.75	−0.20

Notes: The table shows estimated average ASCVD risk in the EvidenceNOW patient population at baseline and post-intervention as well as the absolute and relative change in ASCVD risk for five scenarios: improvement in all ABCS; improvement only in aspirin prescribing; improvement only in blood pressure control; improvement only in cholesterol monitoring; and improvement only in smoking intervention. Results for absolute changes also include bootstrapped p-values in parenthesis. Baseline ASCVD risks are identical for all interventions displayed in the table because they are all based on the full study sample. Baseline levels of ABCS were as follows: 61.9 (aspirin prescribing); 63.3 (blood pressure control); 60.2 (cholesterol management); 58.4 (smoking intervention). Changes in ABCS (if assumed for a scenario) for all practices were: 3.4 (aspirin prescribing); 1.6 (blood pressure control); 4.4 (cholesterol management); 7.4 (smoking intervention). Changes in ABCS (if assumed for a scenario) for practices with median or higher improvements were: 12.9 (aspirin prescribing); 9.4 (blood pressure control); 12.0 (cholesterol management); 20.1 (smoking intervention).
Abbreviation: ASCVD = atherosclerotic cardiovascular disease.

Table 3.

Relative Risk Factors and Risk Reduction Due to Improvements in ABCS

Groups	Relative Population Size (%)	ASCVD Risk at baseline (%)	Contribution to ASCVD reduction (%)
	49.8	7.7	3.6
	33.9	14.9	31.1
	1.6	17.7	4.1
	2.8	13.1	7.8
	4.2	17.2	12.2
	7.8	24.6	41.2
Total	100	10.1	100.0

Notes: The table shows the relative population size, average ASCVD risk at baseline, and contribution to ASCVD reduction. The contribution to ASCVD reduction for each group is calculated as the change in ASCVD risk relative to the overall change in ASCVD risk.
Abbreviations: = people in the denominator for cholesterol management and smoking intervention; = people in the denominator for blood pressure control and smoking intervention; = people in the denominator for aspirin prescription, cholesterol management and smoking intervention; = people in the denominator for blood pressure control, cholesterol management and smoking intervention; = people in the denominator for aspirin prescription, blood pressure control, cholesterol management and smoking intervention. ASCVD = atherosclerotic cardiovascular disease.