Bridging the quality gap in diabetic hyperlipidemia: a practice-based intervention.
OBJECTIVE
Dyslipidemia treatment dramatically decreases coronary heart disease risk in diabetes, yet only a minority of these patients are screened or achieve optimal low-density lipoprotein (LDL) cholesterol levels. Our aim was to increase the percentage of diabetic patients in whom lipid management was achieved through electronic and direct educational detailing.


METHODS
The study cohort comprised 884 diabetic patients at 12 primary care practices. Practice sites were randomized to one of three intervention groups: electronic educational detailing, direct (face-to-face) educational detailing, or control. Direct and electronic detailing were performed over a 12-month period. All sites were notified of our goal to enhance lipid testing among diabetic patients. Chart abstraction was performed 15 months after the start of the intervention. For the entire population (n=884), the proportion of patients with lipid testing was calculated, and changes from pre- to postintervention were compared across groups. We compared pre- and postintervention LDL-cholesterol changes between groups using least square means to account for site variation.


RESULTS
Favorable provider actions increased significantly with the intervention (+22% compared with +6% in controls, P=.01). By logistic regression, electronic detailing increased the likelihood of lipid testing (odds ratio 3.0, confidence interval 1.6-5.7), as did direct detailing (odds ratio 1.8, confidence interval 0.9-3.7) in patients with no preintervention LDL test (n=432). Lipid testing tended to increase to a greater extent at intervention sites (+23% for the combination of electronic and direct detailing vs +11% for controls, P=.06).


CONCLUSIONS
Brief educational detailing either through direct or electronic communication favorably impacts provider behavior regarding dyslipidemia care for diabetic patients.
Mehler
Philip S
PS
Department of Internal Medicine and Cardiology Division at Denver Health, Division of Geriatrics, University of Colorado Health Sciences Center, Denver, Colo, USA. pmehler@dhha.org
Krantz
Mori J
MJ
Lundgren
Rita A
RA
Estacio
Raymond O
RO
MacKenzie
Thomas D
TD
Petralia
Laurel
L
Hiatt
William R
WR
D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000517:prevention & control*; D048909:Diabetes Complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D020407:Internet; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011320:Primary Health Care; D016896:Treatment Outcome