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Research ArticleOriginal Research

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

Deborah J. Cohen, Tamar Wyte-Lake, Pamela Bonsu, Stephanie L. Albert, Lorraine Kwok, Margaret M. Paul, Ann M. Nguyen, Carolyn A. Berry and Donna R. Shelley
The Journal of the American Board of Family Medicine September 2022, jabfm.2022.AP.210502; DOI: https://doi.org/10.3122/jabfm.2022.AP.210502
Deborah J. Cohen
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
PhD
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Tamar Wyte-Lake
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
DPT, MPH
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Pamela Bonsu
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
MPH
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Stephanie L. Albert
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
PhD
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Lorraine Kwok
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
MPH
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Margaret M. Paul
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
PhD
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Ann M. Nguyen
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
PhD, MPH
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Carolyn A. Berry
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
PhD
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Donna R. Shelley
From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
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  • Article
  • Figures & Data
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Article Figures & Data

Tables

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    Table 1.

    Aspirin, Blood Pressure Control, Cholesterol, and Diabetes Management Metrics

    DomainDescriptionDescription - FullNQF
    AspirinAspirin for CVDPercentage of patients 18 years of age and older who were diagnosed with acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months before the measurement period, or who had an active diagnosis of ischemic vascular disease (IV.D) during the measurement period, and who had documentation of use of aspirin or another antiplatelet during the measurement period0068
    Blood PressureHypertension control < 140/90 mm HgPercentage of patients 18 to 85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (< 140/90 mm Hg) during the measurement period0018
    CholesterolStatin therapyPercentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:
    • Adults aged ≥ 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR
    • Adults aged ≥ 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dL; OR
    • Adults aged 40 to 75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70 to 189 mg/dL
    None
    DiabetesPoorly controlled (HbA1c > 9)Percentage of patients 18 to 75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period OR had no measured HbA1c during the measurement period0059
    • Abbreviation: NQF, National Quality Forum.

    • View popup
    Table 2.

    Practice and Patient Characteristics, n = 22

    Practice OwnershipNumberPercentage
    Clinician-owned836.36%
    Hospital-health system418.18%
    Community Health Center1045.45%
    Accountable Care Organization (ACO) involvement
     Part of an ACO731.82%
    RUCA designation
     Metropolitan area core1672.73%
     Metropolitan area high commuting313.64%
     Small town core29.09%
     Rural area14.55%
    Geographic region
     Southwest418.18%
     Northwest418.18%
     Midwest418.18%
     Northeast627.27%
     Southeast418.18%
    Practice size*
     Small (2 to 5 clinicians)1777.27%
     Medium (6 to 10 clinicians)29.09%
     Large (>10 clinicians)313.64%
    Patient characteristics
     Greater than 50% patients indicated  as “non-white”627.27%
     Greater than 50% Medicaid payer731.82%
     Greater than 50% Medicare payer29.09%
    • ↵* This is based on the number of full-time equivalent clinicians (not full-time equivalent primary care clinicians).

    • View popup
    Table 3.

    Type of Professionals Employed by Study Practices

    Embedded Image
    • Abbreviation: CHC, Community Health Centers.

    • View popup
    Table 4.

    Definitions of the Functions and Attributes Reported by Practices with Higher Performance on Chronic Disease Care

    Embedded Image
    • 1Chreim S, Williams BE, Janz L, Dastmalchian A. Change agency in a primary health care context: The case of distributed leadership. Health Care Manage Rev. 2010;35(2):187-199. doi:10.1097/HMR.0b013e3181c8b1f8.

    • Abbreviations: ACO, Accountable Care Organization; QI, quality improvement; MA, Medical assistants; EHR, Electronic Health Record.

    • View popup
    Table 5.

    Quotations to Illustrate Core Functions and Attributes of Practices

    Embedded Image
    • Abbreviations: CHC, Community Health Centers; HHS, Hospital-health systems; FQHC, Federally qualified health centres.

    • View popup
    Table 6.

    Functions and Attributes of Practices with Higher Performance on Chronic Disease Care across Practices

    Embedded Image
    • Abbreviations: CHC, Community Health Centers.

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The Journal of the American Board of Family     Medicine: 38 (1)
The Journal of the American Board of Family Medicine
Vol. 38, Issue 1
January-February 2025
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Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices
Deborah J. Cohen, Tamar Wyte-Lake, Pamela Bonsu, Stephanie L. Albert, Lorraine Kwok, Margaret M. Paul, Ann M. Nguyen, Carolyn A. Berry, Donna R. Shelley
The Journal of the American Board of Family Medicine Sep 2022, jabfm.2022.AP.210502; DOI: 10.3122/jabfm.2022.AP.210502

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Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices
Deborah J. Cohen, Tamar Wyte-Lake, Pamela Bonsu, Stephanie L. Albert, Lorraine Kwok, Margaret M. Paul, Ann M. Nguyen, Carolyn A. Berry, Donna R. Shelley
The Journal of the American Board of Family Medicine Sep 2022, jabfm.2022.AP.210502; DOI: 10.3122/jabfm.2022.AP.210502
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  • Qualitative Research
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