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Physicians' behavior following changes in LDL cholesterol target goals.

Shlomo Vinker1, Haim Bitterman2, Doron Comaneshter2

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Summary

Clalit Health Services stratified LDL-Cholesterol targets by risk, improving LDL-C goal achievement. This change also increased potent statin prescriptions, demonstrating the impact of updated quality indicators.

Keywords:
Clinical guidelinesHypercholesterolemiaQuality indicatorsStatins

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Area of Science:

  • Cardiovascular Medicine
  • Health Services Research
  • Clinical Quality Improvement

Background:

  • Clalit Health Services (CHS) revised its LDL-Cholesterol quality indicators in January 2011.
  • The change shifted from universal targets to risk-stratified targets based on ATP III criteria.

Purpose of the Study:

  • To evaluate the impact of CHS's revised LDL-C targets on achieving LDL-C goals.
  • To assess the effect of the revised targets on physicians' statin prescribing patterns.

Main Methods:

  • A descriptive study utilizing administrative data from June 2010 to June 2012.
  • Analysis included 433,662 patients who remained in their assigned risk group throughout the study period.
  • Measured attainment of LDL-C targets and statin purchases before and after guideline implementation.

Main Results:

  • LDL-C target attainment increased across all risk groups: low (58.6% to 61.6%), medium (55.1% to 61.1%), and high (44.5% to 49.0%).
  • Prescription of potent statins rose significantly in all risk strata: low (3.4% to 5.6%), medium (6.7% to 10.3%), and high (14.5% to 20.3%).
  • All increases were statistically significant (p < 0.001).

Conclusions:

  • The implementation of risk-stratified quality indicators successfully improved LDL-C target achievement.
  • Aligning quality indicators with current scientific literature can drive improvements beyond natural temporal trends.