title: As good as it gets? Managing risks of cardiovascular disease in California's top-performing physician organizations.
abstract: BACKGROUND
  The California Right Care Initiative (RCI) accelerates the adoption of evidence-based guidelines and improved care management practices for conditions for which the gap between science and practice is significant, resulting in preventable disability and death.
  
  
  METHODS
  Medical directors and quality improvement leaders from 11 of the 12 physician organizations that met the 2010 national 90th percentile performance benchmarks for control of hyperlipidemia and glycated hemoglobin in 2011 were interviewed in 2012. Interviews, as well as surveys, assessed performance reporting and feedback to individual physicians; medication management protocols; team-based care management; primary care team huddles; coordination of care between primary care clinicians and specialists; implementation of shared medical appointments; and telephone visits for high-risk patients.
  
  
  RESULTS
  All but 1 of 11 organizations implemented electronic health records. Electronic information exchange between primary care physicians and specialists, however, was uncommon. Few organizations routinely used interdisciplinary team approaches, shared medical appointments, or telephonic strategies for managing cardiovascular risks among patients. Implementation barriers included physicians' resistance to change, limited resources and reimbursement for team approaches, and limited organizational capacity for change. Implementation facilitators included routine use of reliable data to guide improvement, leadership facilitation of change, physician buy-in, health information technology use, and financial incentives.
  
  
  CONCLUSIONS
  To accelerate improvements in managing cardiovascular risks, physician organizations may need to implement strategies involving extensive practice reorganization and work flow redesign.
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ivey
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Raffetto
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vaughn
authors.forename: Margae
authors.initials: M
authors.lastname: Knox
authors.forename: Hattie Rees
authors.initials: HR
authors.lastname: Hanley
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
mesh_terms: D019985:Benchmarking; D002140:California; D002318:Cardiovascular Diseases / Q000628:therapy*; D002985:Clinical Protocols; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D057286:Electronic Health Records; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*; D012017:Referral and Consultation; D012955:Societies, Medical