Abstract
BackgroundIn 01/2011 Clalit Health Services (CHS), changed the LDL-Cholesterol target definitions in its quality indicators program, from a universal target to values stratified by risk assessment based on ATP III criteria. The objective of this study is to evaluate the effect of this change on achievement of LDL-C targets and on physicians’ prescriptions of statins.Study Design: A descriptive study based on administrative dataset 06/2010-06/2012.MethodsSetting: CHS, The largest health maintenance organization in Israel that insures above 4,000,000 beneficiaries.Patients: Patients who had been in the same risk group throughout the study period.Measurements: Attainment of targets for LDL-C and purchases of statins prior to, and following, implementation of the guidelines in the CHS quality indicators program.Results433,662 patients remained in the same risk groups throughout the study period; 55.8% were women; the average age was 53.0 ± 10.3 years; 63.9%, 13.4%, and 22.7% were at low, medium, and high risk respectively. After implementation, the proportion of patients reaching LDL-C targets increased in all risk groups: from 58.6% to 61.6%, from 55.1% to 61.1%, and from 44.5% to 49.0%, in low, medium, and high risk groups respectively (p < 0.001). The proportion of patients treated with potent statins increased in all risk groups; from 3.4% to 5.6%, from 6.7% to 10.3%, and from 14.5% to 20.3% respectively (p < 0.001).ConclusionThe risk stratification approach as a basis for the quality indicators program was implemented and better achievement of target LDL-C levels ensued. We suggest that implementation of quality indicators that are consistent with the current literature can lead to improvements that exceeds temporal trends.
Highlights
In 01/2011 Clalit Health Services (CHS), changed the LDL-Cholesterol target definitions in its quality indicators program, from a universal target to values stratified by risk assessment based on ATP Adult Treatment Panel III (III) criteria
Outcomes were assessed every six months, starting six months prior to implementation of the stratified approach, and continuing until 18 months after implementation. As it was a retrospective study we evaluated at each point only patients with a valid Low density lipoprotein cholesterol (LDL-C) test
The study population included all the 433,362 patients of CHS who remained in the same risk group throughout the study period
Summary
In 01/2011 Clalit Health Services (CHS), changed the LDL-Cholesterol target definitions in its quality indicators program, from a universal target to values stratified by risk assessment based on ATP III criteria. The National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines serves as the benchmark for the assessment of the quality of treatment of hyperlipidemia [6]. Published studies have demonstrated low adherence to them, despite assessment of their relative cost-effectiveness [7]. Computerized clinical decision support systems, including recommendations tailored to patient characteristics, have been shown to mildly increase physician adherence to ATP III guidelines [10], but not to exert a statistically significant effect on LDL-C target achievement [11]. Numerous barriers to guideline adherence by physicians have been identified [12]
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