title: A comprehensive analysis of dyslipidaemia management in a large health care system.
abstract: OBJECTIVE
  Dyslipidaemia is a cardiovascular risk factor, and national screening and treatment guidelines have been established, but achievement of these remains inadequate. Multidisciplinary approaches, such as the chronic care model, have been applied to other chronic diseases and likely would be applicable to the management of dyslipidaemia. We therefore aimed to comprehensively study the different components of a multidisciplinary management approach to dyslipidaemia in a large health care system for patients at a high risk for cardiovascular events.
  
  
  METHODS
  All patients at a Veterans Affairs Medical Center in the United States over 3 years with diabetes and/or coronary artery disease were included. Various clinical and demographic variables were collected and achievement of national cholesterol goals was determined. Univariate and multivariate analyses were conducted to determine the association of different health care variables with improved patient cholesterol guideline achievement.
  
  
  RESULTS
  There were 3559 patients in the study population and 51.0% had achieved national cholesterol goals. Multivariate analyses showed that patients who had achieved goals were more likely to have attended cardiology clinic [odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.3-2.01] and nutrition clinic (OR = 1.3, 95% CI = 1.04-1.7) and were more likely to have primary care providers who were nurse practitioners (OR = 1.6, 95% CI = 1.2-2.0), practicing full-time (OR = 1.8, 95% CI = 1.5-2.1) and at the main hospital-based clinics (OR = 1.5, 95% CI = 1.3-1.9).
  
  
  CONCLUSIONS
  Our study identifies different components of a multidisciplinary approach to management of dyslipidaemia that are efficacious and these results may help guide future investment in this area.
authors.affiliation: Research Enhancement Award Program at the Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sameed Ahmed Mustafa
authors.initials: SA
authors.lastname: Khatana
authors.forename: Lan
authors.initials: L
authors.lastname: Jiang
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D015438:Health Behavior; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012959:Socioeconomic Factors; D014481:United States
keywords: cardiovascular risk; chronic care model; dyslipidaemia; goal achievement; health systems analysis; practice guidelines