Study: Health IT, care coordination key to meeting national cholesterol guidelines
Kaiser Permanente is crediting healthcare information technology and care coordination as helping more than 40 percent of very high-risk patients reach national cholesterol guidelines – a feat that past studies indicate is difficult to achieve.
In 2004 the National Cholesterol Education Program issued revised cholesterol goals recommending people at very high-risk for heart disease move their target LDL or "bad" cholesterol from 100 mg/dL to 70 mg/dL to reduce the risk for another heart attack.
Many health experts have questioned the legitimacy of such an aggressive goal. Previous research has found only between 15 and 30 percent of patients were able to get their cholesterol to the recommended goal.
The study, which is the largest to date demonstrating how many patients can get to the lower goal, found that of the 7,247 Kaiser Permanente patients studied, 43.4 percent lowered their bad cholesterol to less than 70 mg/dL. The majority of patients who attained an LDL less than 70 mg/dL in the study were receiving a statin or a combination of statin and other cholesterol-lowering therapies.
"Kaiser Permanente's integrated care delivery model, supported by electronic medical records and health information technology, has great benefits for patients with heart disease over the long term," said study author Kari Olson, PharmD, BCPS, Clinical Pharmacy Specialist at Kaiser Permanente Colorado. "We believe our patients achieved their cholesterol goals at higher rates because of our proactive team approach, close monitoring and follow-up, and the computer systems we have in place."
Every Kaiser Permanente Colorado patient with a history of heart disease is offered enrollment into a disease management program called the Collaborative Cardiac Care Service. Clinical pharmacy specialists, along with nurses, work to increase the number of patients on long-term lipid-lowering therapy, manage medications known to decrease the risk of future heart attacks, and provide patient education recommendations for a healthy lifestyle. Hospital officials said electronic medical records and computerized disease registries are key to helping care teams coordinate care for this population.
The majority of patients included in this study — nearly 89 percent — attained the old target of less than 100 mg/dL. According to researchers this rate is much higher than national data, which shows that less than 50 percent of patients with heart disease get their LDL to less than 100 mg/dL.
The study also found older patients and men were significantly more likely to attain the LDL cholesterol goal of less than 70 mg/dL. Women were 25 percent more likely to fail to attain goal, as were individuals younger than 65 years and patients not receiving statin therapy. Researchers said they are not certain why women are affected differently.
"Managing cholesterol in patients is difficult, and we know it's much more than writing a prescription and hoping individuals take the medication," said co-author Amy Kauffman, PharmD, of Kaiser Permanente Colorado. "Our study suggests that a combination of care coordination, technology, and close monitoring and follow up may ultimately get more people to the aggressive cholesterol targets over the long term."
Click here to read the full study, which was published in the May issue of the Journal of Clinical Lipidology.