title: Efficiency of the implementation of cardiovascular risk management in primary care practices: an observational study.
abstract: BACKGROUND
  This study aimed to document the variation in technical efficiency of primary care (PC) practices in delivering evidence-based cardiovascular risk management (CVRM) and to identify associated factors.
  
  
  METHODS
  This observational study was based on the follow-up measurements in a cluster randomized trial. Patients were recruited from 41 general practices in the Netherlands, involving 106 GPs and 1671 patients. Data on clinical performance were collected from patient records. The analysis focused on PC practices and used a two-stage data envelopment analysis (DEA) approach. Bias-corrected DEA technical efficiency scores for each PC practice were generated, followed by regression analysis with practice efficiency as outcomes and organizational features of general practice as predictors.
  
  
  RESULTS
  Not all PC practices delivered recommended CVRM with the same technical efficiency; a significant difference from the efficient frontier was found (p < .000; 95 % CI 1.018-1.041). The variation in technical efficiency between PC practices was associated with training practice status (p = .026). Whether CVRM clinical tasks were performed by a practice nurse or a GP did not influence technical efficiency in a statistical significant way neither did practice size.
  
  
  CONCLUSIONS
  Technical efficiency in delivering evidence-based CVRM increased with having a training practice status. Nurse involvement and practice size showed no statistical impact.
authors.affiliation: Radboud Institute for Health Sciences, Department for Health Evidence (133), Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. eddy.adang@radboudumc.nl.
authors.forename: Eddy M M
authors.initials: EM
authors.lastname: Adang
authors.affiliation: Radboud Institute for Health Sciences, Department for Health Evidence (133), Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Gerritsma
authors.affiliation: Radboud Institute for Health Sciences, Department of IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Elvira
authors.initials: E
authors.lastname: Nouwens
authors.affiliation: Radboud Institute for Health Sciences, Department of IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.affiliation: Radboud Institute for Health Sciences, Department of IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D002318:Cardiovascular Diseases / Q000628:therapy; D016000:Cluster Analysis; D058006:General Practice / Q000379:methods; D006284:Health Plan Implementation / Q000379:methods; D009426:Netherlands; D011320:Primary Health Care; D012307:Risk Factors; D012308:Risk Management / Q000379:methods; D016896:Treatment Outcome
keywords: Cardiovascular risk management; Data envelopment analysis; Primary care; Technical efficiency