Improving smoking and blood pressure outcomes with operational changes

Cardiovascular disease (CVD) is the leading cause of death in the United States. Primary risk factors for CVD include high blood pressure (BP), high cholesterol levels, and smoking. These risk factors are often preventable or treatable with low-cost, evidence-based interventions. Yet, uptake of these clinical interventions is low.

A research team led by OHSU Family Medicine’s Deborah Cohen, Ph.D., studied various conditions and operational changes that led to improvements in both smoking cessation counseling and blood pressure outcomes in primary care.

The study, published in the Annals of Family Medicine, is part of the Agency for Healthcare Research and Quality’s CVD prevention initiative EvidenceNOW, which provides external support to primary care practices to improve the quality of care.

  • Smoking cessation counseling outcomes improved with a moderate level of facilitation when clinician-owned practices:
    • Implemented a workflow to routinely screen, counsel, and connect patients to smoking cessation resources
    • Implemented a documentation change or a referral to a resource
  • Blood pressure outcomes improved for smaller practices with a moderate level of facilitation when:
    • MAs were trained to take an accurate BP
    • Practices implemented a second BP measurement when the first was elevated
    • Staff learned where to document BP measurements in the EHR
    • For larger hospital or health system–owned practices and Federally Qualified Health Centers, more facilitation was necessary

There was no magic bullet for improving smoking cessation counseling and BP outcomes across the diverse primary care practices studied. Combinations of operational changes among practice sizes and types led to improvements – as the paper states, “Our analyses underscore the value of methods that can identify how particular factors work together to explain improvement in clinical outcomes.”

This paper is coauthored by Shannon M. SweeneyWilliam L. MillerJennifer D. HallEdward J. MiechRachel J. SpringerBijal A. BalasubramanianLaura Damschroder, and Miguel Marino. The work was funded by the Agency for Healthcare Research and Quality (grant number R01HS023940-01).