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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1077 — Correlates of Multiple Lipid Panels in Patients with Coronary Heart Disease Who Have Achieved LDL Cholesterol Treatment Goals

Virani SSWoodard LDWang DLandrum CRChitwood SSUrech TH, and Pietz K, HSR&D, Michael E. DeBakey VAMC, Houston; Hertz B, VA Great Lakes Healthcare System; Ballantyne CM, Baylor College of Medicine; Petersen LA, HSR&D, Michael E. DeBakey VAMC, Houston

Objectives:
Current guidelines and performance metrics recommend annual lipid testing with low-density-lipoprotein cholesterol (LDL-C) levels <100mg/dL in coronary heart disease (CHD) patients. Our objective was to assess frequency and correlates of repeat lipid testing in CHD patients who have attained LDL-C goals and receive no further treatment intensification.

Methods:
We used administrative data to assess 35,191 CHD patients in one Veterans Affairs network during fiscal year 2009. We determined the proportion of patients with LDL-C <100 mg/dL with no further treatment intensification with lipid lowering therapy at 45 days follow-up from the first lipid panel, who had repeat lipid testing performed over the following 11 months. We performed logistic regression to evaluate characteristics associated with repeat lipid testing in CHD patients.

Results:
LDL-C levels were <100mg/dL in 79.4% patients (n = 27,947). 9,200 patients (26%) with LDL-C <100mg/dL had additional lipid panels performed without treatment intensification over the following 11 months (total additional lipid panels = 12,686; mean = 1.38 additional lipid panel/patient). Adjusting for clustering between facilities, patients with concomitant diabetes (OR 1.16, 95% CI 1.10-1.22), hypertension (OR 1.21, 95% CI 1.13-1.30), a higher illness burden [diagnostic cost-group relative-risk score >2.00] (OR 1.39, 95% CI 1.23-1.57), female gender (OR 1.28, 95% CI 1.00-1.65; borderline significant), and a higher number of primary care visits (OR 1.32, 95% CI 1.25-1.39) were associated with repeat lipid panels. Alternatively, receiving care at a teaching facility (OR 0.74, 95% CI 0.69-0.80) or from a physician provider [versus physician assistants or nurse practitioners] (OR 0.93, 95% CI 0.88-0.98), a larger provider panel size (OR 0.98, 95% CI 0.97-0.99), and good medication adherence [medication possession ratio >0.8] (OR 0.75, 95% CI 0.71-0.80) were associated with a lower likelihood of repeat lipid testing.

Implications:
One fourth of CHD patients with LDL-C at goal had repeat lipid panels performed within 11 months of their index lipid panel. Female CHD patients, those with higher illness burden, and patients with more frequent provider visits are more likely to have repeat lipid panels.

Impacts:
Our results highlight areas to target for future quality improvement initiatives aimed at reducing redundant lipid testing in CHD patients who have attained LDL-C goals.


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