Quality improvement for prevention of cardiovascular disease and stroke in an academic family medicine center: do racial differences in outcome exist?
OBJECTIVE
We evaluated whether a one-year, multifaceted quality improvement intervention improved adherence to 13 clinical guidelines for lipid screening, hypertension management, and diabetes management among White and African-American adult patients.


METHODS
An academic family medicine center.


METHODS
Six faculty physicians and a clinical pharmacist participated between July 1, 2002, and June 30, 2003. Data from 2860 patients' electronic medical records were abstracted.


METHODS
Performance reports and lists of patients eligible for each guideline measure were generated. Interventions targeted patients who needed improvement. Statistical analyses used generalized estimating equations to determine the intervention effect.


RESULTS
Significant improvements occurred in blood pressure control for all adults (OR= 1.44) and those with hypertension (OR=1.82), measures of total cholesterol (OR=1.10) and high-density lipoprotein cholesterol (OR= 1.27) for all patients, and measure of low-density lipoprotein cholesterol (OR=2.01) and blood pressure control (OR=1.71) for patients with diabetes mellitus. Significant decline was seen in measures of blood pressure for all patients (OR=.60). After adjusting for patient demographic factors, provider variability, and comorbidities, race was not associated with the change observed in any of the measures from baseline to follow-up.


CONCLUSIONS
Even though a multifaceted intervention can improve process of care measures for Whites and African Americans, further studies are needed to improve outcome measures, especially in African Americans.
Jenkins
Ruth G
RG
Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA. jenkinsr@musc.edu
Ornstein
Steven M
SM
Nietert
Paul J
PJ
Klockars
Sara J
SJ
Thiedke
Carolyn
C
D000046:Academic Medical Centers; D000328:Adult; D001741:Black or African American; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D013022:South Carolina; D020521:Stroke / Q000517:prevention & control*; D017749:Total Quality Management / Q000458:organization & administration*; D044465:White People