Management of Cardiovascular Disease Risk Factors by Rural and Urban Primary Care Practices

In the United States, over 650,000 people die annually from cardiovascular disease (CVD) with high associated health care and economic costs.1 Despite a strong scientific basis for their beneficial impact on health,2 rates of preventive screening remain low.3 Levels of adherence to preventive guidelines are even lower in African American populations, socioeconomically disadvantaged populations, and underserved rural populations.4 Rural populations have higher rates of modifiable risk factors—obesity, smoking, physical inactivity—for CVD than urban populations and bear a disproportionate burden from CVD.5–7 Rates of undiagnosed and poorly treated high blood pressure are more common in rural areas.8,9 Racial/ethnic minority populations also face higher CVD risk factors.6,10 Screening, prevention, and management of CVD and its risk factors largely occur in primary care settings, particularly in rural areas.11 With an increasing emphasis on value-based payment and quality reporting, it remains unknown if rural primary care practices have closed gaps in care with urban practices for all patients, especially for racial/ethnic minority patients, on quality-of-care measures related to CVD screening, prevention, and treatment. This information would be critical to evaluate whether changes in practice incentives can improve population health. Such knowledge may be used by policy makers to identify quality gaps for rural populations that can be targeted with payment incentives, or extra resources, to decrease the burden of CVD in rural populations. Our objective is to compare management of CVD risk factors between rural and urban practices, using quality measures, in a large national primary care registry. We also assess for differences by the composition of patients in the practice who are racial/ethnic minorities or who live in socioeconomically deprived areas.