Improving care to patients with ischemic heart disease: experiences in a single network of the Veterans Health Administration.
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.


OBJECTIVE
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.


CONCLUSIONS
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.


CONCLUSIONS
Overall, the three facilities improved in lipid measurement and management for patients with coronary artery disease.
Pineros
Sandra L
SL
Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98108, USA. Sandra.Pineros@med.va.gov
Sales
Anne E
AE
Li
Yu-Fang
YF
Sharp
Nancy D
ND
D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D030141:Feedback, Psychological; D019983:Guideline Adherence / Q000458:organization & administration*; D006787:Hospitals, Veterans; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000517:prevention & control; D008485:Medical Audit; D020380:Needs Assessment; D015205:Northwestern United States / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic; D010607:Pharmacy Service, Hospital; D010865:Pilot Projects; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012008:Recurrence; D017010:Reminder Systems; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs
D008078:Cholesterol, LDL