Clinical Operations Variables are Associated With Blood Pressure Outcomes.
Clinical Operations Variables are Associated With Blood Pressure Outcomes.
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DOI：
10.1097/mlr.0000000000000349
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发表时间：
2015-06
期刊：
影响因子：
3
通讯作者：
Pizer SD
中科院分区：
文献类型：
--
作者：
Kressin NR;Lasser KE;Paasche-Orlow M;Allison J;Ash AS;Adams WG;Shanahan CW;Legler A;Pizer SD
在被诊断和治疗的患者中，血压（BP）不受控制仍然是一个重要的临床挑战;如果临床操作的各个方面与更好的结局相关，则可能会进行调整。探讨临床操作因素对血压控制正常化的影响。观察性队列研究。来自大型城市临床实践的高血压患者（2005-2009年）。我们获得了BP的临床数据，按人月组织，以及PCP人员配置的管理数据。我们评估了作为时变协变量的函数的不受控制的BP发作的解决方案，包括实践水平的预约量、个体临床医生的预约量、整体实践水平的初级保健提供者（PCP）人员配备和独特PCP的数量。在代表50，403人月的7，409例独特患者中，在独特PCP数量较高的月份内发作的患者不太可能正常化（独特PCP的前五分位数与正常化概率低9个百分点相关（P < 0.01）比最低五分位数）。实践预约量对正常化的可能性产生负面影响（在预约最多的月份开始的发作与正常化概率降低6个百分点相关（P = 0.01））。无论是临床医生的预约量，也没有实践临床医生的人员配备水平显着相关的正常化的概率。研究结果表明，临床操作因素可以影响临床结果，如BP正常化，并指出组织临床护理时考虑结果影响的重要性。
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. To assess clinical operations factors’ effects on normalization of uncontrolled BP. Observational cohort study. Patients diagnosed with hypertension from a large urban clinical practice (2005–2009). We obtained clinical data on BP, organized by person-month, and administrative data on 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 primary care provider (PCP) staffing and number of unique PCPs. Among 7,409 unique patients representing 50,403 person-months, normalization was less likely for patients with episode starts during months when the number of unique PCPs was 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. 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.