Improvement and Implementation Science to Optimize Statin Therapy in Primary Prevention.

Area of Science:

• Quality Improvement
• Implementation Science
• Preventive Cardiology

Background:

• Statin therapy is underprescribed for primary prevention in the US, with less than 1/5th of eligible patients receiving it.
• A gap exists in optimizing statin use for primary prevention among adults without atherosclerotic cardiovascular diseases (ASCVD).

Purpose of the Study:

• To enhance statin therapy optimization in primary prevention for eligible patients aged 40-75 without ASCVD.
• To implement and evaluate a quality improvement program using contextually responsive implementation strategies.

Main Methods:

• A quality improvement program was conducted in a resident internal medicine clinic.
• Plan-Do-Study-Act cycles and Lean Six Sigma principles were employed.
• Needs assessments, barrier identification, and mapping of implementation strategies (IS) using the ERIC taxonomy were performed over two years.

Main Results:

• Significant improvements were observed in lipid panel orders (64.6% to 95.5%) and completion (78.6% to 95.3%).
• ASCVD risk score completion increased dramatically from 3% to 91%.
• Statin therapy optimization rose from 34.5% to 90% in the eligible patient cohort.

Conclusions:

• Improvement and implementation science approaches are effective for identifying needs and barriers to statin optimization.
• Mapping implementation strategies to identified barriers can significantly improve statin use for primary prevention.
• Reporting implementation strategies using the ERIC taxonomy aids in operationalizing these strategies in diverse settings.