title: Using Principles of Complex Adaptive Systems to Implement Secondary Prevention of Coronary Heart Disease in Primary Care.
abstract: Primary care practice.
  
  
  
  To test whether the principles of complex adaptive systems are applicable to implementation of team-based primary care.
  
  
  
  We used complex adaptive system principles to implement team-based care in a private, five-clinic primary care practice. We compared randomly selected samples of patients with coronary heart disease (CHD) and diabetes before system implementation (March 1, 2009, to February 28, 2010) and after system implementation (December 1, 2011, to March 31, 2013).
  
  
  
  Rates of patients meeting the composite goals for CHD (blood pressure < 140/90 mmHg, low-density lipoprotein cholesterol level < 100 mg/dL, tobacco-free, and using aspirin unless contraindicated) and diabetes (CHD goal plus hemoglobin A1c concentration < 8%) before and after the intervention. We also measured provider and patient satisfaction with preventive services.
  
  
  
  The proportion of patients with CHD who met the composite goal increased from 40.3% to 59.9% (p < 0.0001) because documented aspirin use increased (65.2%-97.5%, p < 0.0001) and attainment of the cholesterol goal increased (77.0%-83.9%, p = 0.0041). The proportion of diabetic patients meeting the composite goal rose from 24.5% to 45.4% (p < 0.0001) because aspirin use increased (58.6%-97.6%, p < 0.0001). Increased percentages of patients meeting the CHD and diabetes composite goals were not significantly different (p = 0.2319). Provider satisfaction with preventive services delivery increased significantly (p = 0.0017). Patient satisfaction improved but not significantly.
  
  
  
  Principles of complex adaptive systems can be used to implement team-based care systems for patients with CHD and possibly diabetic patients.
authors.affiliation: Medical Director for Population Health for HealthPartners and a Senior Clinical Investigator for HealthPartners Institute for Education and Research in Minneapolis, MN, and a Professor at the University of Minnesota Medical School in Minneapolis. thomas.e.kottke@healthpartners.com.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kottke
authors.affiliation: Research Fellow for HealthPartners Institute for Education and Research in Minneapolis, MN. jacquelyn.a.huebsch@healthpartners.com.
authors.forename: Jacquelyn A
authors.initials: JA
authors.lastname: Huebsch
authors.affiliation: Family Medicine Physician for Hudson Physicians in WI. pmcginnis@hudsonphysicians.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Mcginnis
authors.affiliation: Quality Improvement Nurse for Hudson Physicians in WI. jnichols@hudsonphysicians.com.
authors.forename: Jolleen M
authors.initials: JM
authors.lastname: Nichols
authors.affiliation: Research Investigator for HealthPartners Institute of Education and Research in Minneapolis, MN. emily.d.parker@healthpartners.com.
authors.forename: Emily D
authors.initials: ED
authors.lastname: Parker
authors.affiliation: Project Management Consultant for HealthPartners Institute of Education and Research in Minneapolis, MN. juliana.o.tillema@healthpartners.com.
authors.forename: Juliana O
authors.initials: JO
authors.lastname: Tillema
authors.affiliation: Senior Research Investigator for HealthPartners Institute of Education and Research in Minneapolis, MN. michael.v.maciosek@healthpartners.com.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Maciosek
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011320:Primary Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D055502:Secondary Prevention