title: Improved cardiac management with a disease management program incorporating comprehensive lipid profiling.
abstract: The objective of this study was to evaluate the improved effectiveness of a disease management treatment protocol incorporating comprehensive lipid profiling and targeted lipid care based on lipid profile findings in patients with ischemic heart disease (IHD) or congestive heart failure (CHF) enrolled in a managed care plan. This retrospective cohort study, conducted over a 2-year period, compared outcomes between patients with a standard lipid profile to those evaluated with a comprehensive lipid profile. All adult members of the WellMed Medical Management, Inc. managed care health plan diagnosed with IHD or CHF, and continuously enrolled between July 1, 2006 and June 30, 2008, were included in the study. Cases were defined as those who had at least 1 comprehensive lipid test (the VAP [vertical auto profile] ultracentrifuge test) during this period (n=1767); they were compared to those who had no lipid testing or traditional standard lipid testing only (controls, n=289). Univariate statistics were analyzed to describe the groups, and bivariate t tests or chi-squares examined differences between the 2 cohorts. Multivariate regression analyses were performed to control for potential confounders. The results show that the case group had lower total costs ($4852.62 vs. $7413.18; P=0.0255), fewer inpatient stays (13.1% vs. 18.3% of controls; P=0.0175) and emergency department visits (11.9% vs. 15.6% of controls; P=0.0832). Prescription use and frequency of lipid measurement suggested improved control resulting from a targeted approach to managing specific dyslipidemias. A treatment protocol incorporating a comprehensive lipid profile appears to improve care and reduce utilization and costs in a disease management program for cardiac patients.
authors.affiliation: Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. john.mcana@jefferson.edu
authors.forename: John F
authors.initials: JF
authors.lastname: McAna
authors.forename: Neil I
authors.initials: NI
authors.lastname: Goldfarb
authors.forename: Joseph
authors.initials: J
authors.lastname: Couto
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Henry
authors.forename: Gary
authors.initials: G
authors.lastname: Piefer
authors.forename: George M
authors.initials: GM
authors.lastname: Rapier
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D019468:Disease Management; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000191:economics / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008055:Lipids / Q000097:blood*; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D055118:Medication Adherence; D017202:Myocardial Ischemia / Q000097:blood / Q000191:economics / Q000628:therapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids