Sandra L Pineros1, Anne E Sales, Yu-Fang Li, Nancy D Sharp. 1. Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98108, USA. Sandra.Pineros@med.va.gov
Abstract
BACKGROUND: Ischemic heart disease (IHD) is the leading cause of death in the United States. Lowering serum cholesterol levels reduces coronary events and mortality; this effect is most evident in patients with preexisting IHD. AIMS: The primary aim of this article is to describe a set of interventions that were piloted in a single, regional Veterans Integrated Service Network (VISN) to promote secondary prevention among patients with IHD and to explore the effect of those interventions on patient outcomes. METHODS: An observational, before-and-after study of clinical interventions to improve lipid guideline compliance in VISN 20 (the Veterans Administration Northwest Network) was conducted. A total of 2,467 patients with established coronary artery disease from three medical facilities in VISN 20 were included. Each medical facility chose different interventions to lower low-density lipoprotein cholesterol (LDL-c) levels in their patients. One facility chose a paper point-of-care reminder, a second chose a lipid clinic, and a third chose audit/feedback to clinicians in addition to a patient-education component. Data came from a relational database that mirrors the clinical information system at each site. Outcomes included the proportion of patients who had their LDL-c measured, the proportion of patients who had lipid-lowering agents prescribed, and the proportion of patients at LDL-c goal of lower than 100 mg/dL measured before, during, and after the intervention period. RESULTS: Statistically significant improvements were observed within sites after the interventions were implemented. IMPLICATIONS FOR PRACTICE: Interventions that focused on secondary prevention in this high-risk group were moderately successful in changing practice. Tailoring interventions to the needs of a specific site of care is feasible and may add to the likelihood of succeeding. CONCLUSION: Overall, the three facilities improved in lipid measurement and management for patients with coronary artery disease.
BACKGROUND:Ischemic heart disease (IHD) is the leading cause of death in the United States. Lowering serum cholesterol levels reduces coronary events and mortality; this effect is most evident in patients with preexisting IHD. AIMS: The primary aim of this article is to describe a set of interventions that were piloted in a single, regional Veterans Integrated Service Network (VISN) to promote secondary prevention among patients with IHD and to explore the effect of those interventions on patient outcomes. METHODS: An observational, before-and-after study of clinical interventions to improve lipid guideline compliance in VISN 20 (the Veterans Administration Northwest Network) was conducted. A total of 2,467 patients with established coronary artery disease from three medical facilities in VISN 20 were included. Each medical facility chose different interventions to lower low-density lipoprotein cholesterol (LDL-c) levels in their patients. One facility chose a paper point-of-care reminder, a second chose a lipid clinic, and a third chose audit/feedback to clinicians in addition to a patient-education component. Data came from a relational database that mirrors the clinical information system at each site. Outcomes included the proportion of patients who had their LDL-c measured, the proportion of patients who had lipid-lowering agents prescribed, and the proportion of patients at LDL-c goal of lower than 100 mg/dL measured before, during, and after the intervention period. RESULTS: Statistically significant improvements were observed within sites after the interventions were implemented. IMPLICATIONS FOR PRACTICE: Interventions that focused on secondary prevention in this high-risk group were moderately successful in changing practice. Tailoring interventions to the needs of a specific site of care is feasible and may add to the likelihood of succeeding. CONCLUSION: Overall, the three facilities improved in lipid measurement and management for patients with coronary artery disease.
Authors: Hildi Hagedorn; Mary Hogan; Jeffrey L Smith; Candice Bowman; Geoffrey M Curran; Donna Espadas; Barbara Kimmel; Laura Kochevar; Marcia W Legro; Anne E Sales Journal: J Gen Intern Med Date: 2006-02 Impact factor: 5.128
Authors: Jennifer Kononowech; Hildi Hagedorn; Carmen Hall; Christian D Helfrich; Anne C Lambert-Kerzner; Susan C Miller; Anne E Sales; Laura Damschroder Journal: Implement Sci Commun Date: 2021-02-13
Authors: Anne Sales; Christian Helfrich; P Michael Ho; Ashley Hedeen; Mary E Plomondon; Yu-Fang Li; Alison Connors; John S Rumsfeld Journal: Implement Sci Date: 2008-05-29 Impact factor: 7.327