Abstract P132: QUICC: Quality Initiative to Improve Cholesterol Care

Abstract

Background: An initial quality audit identified areas of improvement in cholesterol management for diabetic patients. The goal of this project was to assess the success of targeted quality improvement (QI) initiatives regarding evidence based cholesterol management in this population. Methods: Following an initial QI audit the following actions were initiated (~01/2008): clinician education, clinical notes added to disease management database, and electronic medical records critical alerts placed on diabetic patient records regarding cholesterol treatment (prescribing and goal attainment). Eighteen months following the implementation of these initiatives, a retrospective chart review was conducted with identical methodology as the initial QI audit. Inclusion criteria were: diabetic patients aged 18 - 89 years seen in a comprehensive lipid clinic within the past year. Objectives included the change in percent of patients receiving cholesterol medication according to ADA guidelines and change in percent of patients at LDL goal, per NCEP guidelines. T-test was used to analyze data. Results: Fifty-six patients included in this analysis were compared to 134 patients from the baseline analysis. Average age of this population was 66 ± 11 years, 54% (30/56) were male, and 77% (43/56) had coronary disease. There were no differences in demographics between groups. Results of the current data demonstrate cholesterol prescribing according to guidelines was seen in 98% (55/56) of patients overall; 98% (47/48) of patients receiving statins for secondary prevention, and 100% (8/8) of patients receiving statins for primary prevention. These results are significantly higher compared to baseline data where 81% (109/134), 84% (86/102), and 72% (23/32) of patients, respectively, received medication according to guidelines, p<0.05 for all comparisons. In addition, a significantly higher percent of patients achieved LDL goal < 100 mg/dL (71%; 40/56) in this analysis compared to the baseline analysis (61%; 82/134), p<0.05. Conclusions: These data demonstrate that QI initiatives, including education, electronic database management, and clinical alerts positively impacts evidence-based prescribing and cholesterol goal attainment in diabetic patients.