Abstract
This study investigates if laboratory data can be used to assess whether physician-retesting patterns are in line with established guidelines, and if these guidelines identify deteriorating patients in a timely manner. A total of 7594 patients with high cholesterol were studied, along with 2764 patients with diabetes. More than 90% of borderline high cholesterol patients are retested within the 3 year recommended period, however less than 75% of pre-diabetic patients have repeated tests within the suggested 1-year time frame. Patients with borderline high cholesterol typically progress to full high cholesterol in 2–3 years, and pre-diabetic patients progress to full diabetes in 1–2 years. Data from routinely ordered laboratory tests can be used to monitor adherence to clinical guidelines. These data may also be useful in the design of adaptive testing strategies that reduce unnecessary testing, while ensuring that patient deterioration is identified in a timely manner. Established guidelines for testing of total serum cholesterol for hypercholesterolemia are appropriate and are well-adhered to, whereas guidelines for glycated hemoglobin A1c testing for type 2 diabetes mellitus could be improved to bring them in line with current practice and avoid unnecessary testing.
Highlights
Cardiovascular disease (CVD), including ischemic heart disease and stroke, is the primary cause of death worldwide, leading to 32% of all deaths worldwide in the year 20131
All data from Stanford Translational Research Integrated Database Environment (STRIDE) is compliant with the Health Insurance Portability and Accountability Act (HIPAA); all information that could lead to identification of a study participant has been removed by a third party before it is accessed by any researcher involved in this study
This study examines the time taken for a patient to progress from a pre-disease state, such as borderline hypercholesterolemia or pre-diabetes, to a full disease state; inclusion in the cohort required at least one test result in the pre-disease range before a test result in the full-disease range
Summary
Cardiovascular disease (CVD), including ischemic heart disease and stroke, is the primary cause of death worldwide, leading to 32% of all deaths worldwide in the year 20131. Type 2 diabetes mellitus and hypercholesterolemia are well established modifiable risk factors for CVD3, 4, and are diagnosable with simple laboratory tests[5]. We use routinely collected laboratory data to assess whether established guidelines for screening of hypercholesterolemia and type 2 diabetes mellitus capture deteriorating patients in a timely fashion that allows early lifestyle intervention for possible prevention of CVD. We hope to show that access to large amounts of data allows differences between recommended retesting and actual practice patterns to be identified[16], irrespective of the disease being screened for Based on these findings, changes can be made to adjust retesting time, or to encourage physician adherence to guidelines in order to minimize the differences between recommended and actual retesting. Within 3 years Begin screening at age 45, repeat every 3 years Begin screening at age 18, repeat every 3 years Within 12 months Within 4 months
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