title: Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?
abstract: BACKGROUND
  Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care.
  
  
  METHODS
  An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM.
  
  
  RESULTS
  The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score 'Preventive Services' (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001).
  
  
  CONCLUSIONS
  There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital of Heidelberg, Voßstrasse 2, D-69115 Heidelberg, Germany. sabine.ludt@med.uni-heidelberg.de
authors.forename: Sabine
authors.initials: S
authors.lastname: Ludt
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Campbell
authors.forename: Davorina
authors.initials: D
authors.lastname: Petek
authors.forename: Justine
authors.initials: J
authors.lastname: Rochon
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Dominik
authors.initials: D
authors.lastname: Ose
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D005060:Europe; D005260:Female; D058006:General Practice / Q000458:organization & administration / Q000592:standards*; D006293:Health Promotion / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012308:Risk Management / Q000592:standards