Assessing appropriateness of lipid management among patients with diabetes mellitus moving from target to treatment

Ashley J. Beard, Timothy P. Hofer, John R. Downs, Michelle Lucatorto, Mandi L. Klamerus, Rob Holleman, Eve A. Kerr

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background-Performance measures that emphasize only a treat-to-target approach may motivate overtreatment with highdose statins, potentially leading to adverse events and unnecessary costs. We developed a clinical action performance measure for lipid management in patients with diabetes mellitus that is designed to encourage appropriate treatment with moderate-dose statins while minimizing overtreatment. Methods and Results-We examined data from July 2010 to June 2011 for 964 818 active Veterans Affairs primary care patients =18 years of age with diabetes mellitus. We defined 3 conditions as successfully meeting the clinical action measure for patients 50 to 75 years old: (1) having a low-density lipoprotein (LDL) <100 mg/dL, (2) taking a moderatedose statin regardless of LDL level or measurement, or (3) receiving appropriate clinical action (starting, switching, or intensifying statin therapy) if LDL is =100 mg/dL. We examined possible overtreatment for patients =18 years of age by examining the proportion of patients without ischemic heart disease who were on a high-dose statin. We then examined variability in measure attainment across 881 facilities using 2-level hierarchical multivariable logistic models. Of 668 209 patients with diabetes mellitus who were 50 to 75 years of age, 84.6% passed the clinical action measure: 67.2% with LDL <100 mg/dL, 13.0% with LDL =100 mg/dL and either on a moderate-dose statin (7.5%) or with appropriate clinical action (5.5%), and 4.4% with no index LDL on at least a moderate-dose statin. Of the entire cohort =18 years of age, 13.7% were potentially overtreated. Facilities with higher rates of meeting the current threshold measure (LDL <100 mg/ dL) had higher rates of potential overtreatment (P<0.001). Conclusions-Use of a performance measure that credits appropriate clinical action indicates that almost 85% of diabetic veterans 50 to 75 years of age are receiving appropriate dyslipidemia management. However, many patients are potentially overtreated with high-dose statins.

Original languageEnglish (US)
Pages (from-to)66-74
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Volume6
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Keywords

  • Cholesterol
  • Diabetes mellitus
  • Lipids
  • Performance measures
  • Quality of care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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