Abstract P40: The Impact of a COSEHC Physician Education Program on Patient Cardiovascular Disease Risk Variables in a Large South Carolina Medical Practice

Abstract

COSEHC is conducting an 18-month prospective nested cohort design study, COSMIC [ CO SEHC Cu S tomized Model of Intervention and Care], which evaluates the effectiveness of a physician process improvement education program to reduce gaps in physicians’ application of cardiovascular disease (CVD) guidelines in a primary care South Carolina (SC) practice. The COSMIC project evaluates patient CVD risk variable outcomes as a measure of physician improvement. This study evaluates changes in patient CVD risk between baseline (BL) and 6 months (6-mo) among physician cohort 1 (CH1; n=1200 patient records) receiving COSMIC physician education and the control group (cohort 2 (CH2); n=1200 patient records). The COSMIC program involves educational modules that promote clinical care systems changes using JNC 7 and ATP III revised guidelines followed by a repeat process based on reassessed outcomes. At 6-mo, there was statistically more improvement in diastolic blood pressure (DBP) for CH2 than CH1. However, no other CVD outcomes changes were noted between CH1 and CH2 for systolic blood pressure (SBP) total, LDL, or HDL cholesterol (TC, LDL-C, HDL-C), triglycerides, hemoglobin A1c (HgA1c), creatinine, or body mass index (BMI)] using the last observation carried forward method ( Table 1 ). While improvements in TC, triglycerides, and HgA1c increased for both groups at 6-mo, CH1 tended to have smaller increases than CH2, respectively. Changes in LDL-C showed improvement for CH1 at 6-mo while CH2 did not improve. Additionally, CH1 had a higher percentage of total patients with return values/visits for each CVD risk factor. This project, while showing no statistically significant changes over 6-mo other than DBP, reveals a trend for modest improvements with physician education for 6-mo in a SC primary care practice. Continuation of this program inclusive of improved clinical care systems will determine the ultimate impact on improving CVD risk in the Southeast United States. Table 1. A comparison of changes in CVD risk factors between BL and 6-mo among CH1 and CH2. * p < 0.05 Cohort 1 (mean ± SD) Cohort 2 (mean ± SD) Changes in Systolic Blood Pressure (mm Hg) -0.91 ± 15.56 -1.79 ± 15.11 Chanegs in Diastolic Blood Pressure (mm Hg) -0.76 ± 9.47 * -1.74 ± 8.63 Changes in Total Cholesterol (mg/dL) 0.92 ± 22.79 1.57 ± 22.39 Changes in LDL Cholesterol (mg/dL) -0.34 ± 19.58 0.08 ± 18.15 Changes in HDL Cholesterol (mg/dL) 1.04 ± 5.87 1.01 ± 5.34 Changes in Triglycerides (mg/dL) 0.55 ± 37.01 0.74 ± 37.81 Changes in Hemoglobin A1c (%) 0.003 ± 0.59 0.062 ± 0.68 Changes in Creatinine (mg/dL) -0.03 ± 0.16 -0.03 ± 0.13 Changes in Body Mass Index (BMI) 0.07 ± 2.12 0.08 ± 1.69