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93. Lipid Measurement and Management among VA Patients with Ischemic Heart Disease

AE Sales, VA Puget Sound Health Care System; KL Sloan, VA Puget Sound Health Care System; S Pineros, VA Puget Sound Health Care System; H Sun, VA Puget Sound Health Care System; NR Every, VA Puget Sound Health Care System; G Martin, VA Puget Sound Health Care System; J Rothendler, Bedford VAMC; J Saucedo, Little Rock VAMC; J Bates, VISN 16; B Lancaster, VISN 16

Objectives: To identify all VA patients receiving primary care in VISNs 1, 16, 20 and the Cincinnati VAMC who have been diagnosed with Ischemic Heart Disease (IHD); to design, validate, and implement a secondary data system to capture lipid monitoring and treatment of lipid disorders in this population.

Methods: This was a descriptive population study, examining data for all IHD patients in 3 VISNs and one VAMC. We extracted data from VA databases to identify patients with IHD and to capture lipid monitoring and treatment. Data fields extracted included cardiac revascularization procedures, inpatient admissions for IHD-related problems, outpatient visits for IHD-related care, and lab and pharmacy tests and results. We include all identified IHD patients receiving primary care in FY99 in all facilities participating in the study.

Results: We identified a total of 42,638 patients with IHD in VISNs 1, 16, 20, and the Cincinnati VAMC (number of facilities = 26). Prevalence rates for IHD based on our findings average between 10 and 12%. For all patients, the rate of current (within 15 months of data extraction) LDL testing was 66% (VISN range 56-78%), and the rate of current lipid lowering agent treatment was 56% (range 56-57%). Mean LDL value for the whole sample was 109.49 (s.d. 33.38). The proportion of IHD patients who had attained the goal of 100 mg/dL serum LDL or less was 42% (s.d. 49%). The range of proportion of patients at goal for the four geographic sites in the study was 40-46%. Our primary findings show differences at the VISN level among the sites in the study. Variation exists at this level in the major findings of interest, but much greater variation exists among individual facilities within a VISN. The range of current LDL testing rates among the 26 facilities in the study is 37% to 82%.

Conclusions: Overall, the rates of LDL measurement in this population of patients with known IHD are similar to those in the private sector. However, there is still a relatively large gap in measurement. In addition, the proportion of patients at the guideline-recommended goal is still lower than desired. Improvement in all these measures is both possible and desirable.

Impact: This is the largest study of its kind conducted in the VA to date. We have fully characterized essential dimensions of measurement and treatment of dyslipidemia in an IHD patient population. The gaps between ideal (as recommended by guidelines) and actual practice are amenable to improvement. The range of rates of testing and lipid lowering agent treatment at the facility level, in particular, offers the opportunity for discovering ways of improving care in this very important arena.