title: Current quality of cardiovascular prevention for Million Hearts: an analysis of 147,038 outpatients from The Guideline Advantage.
abstract: BACKGROUND
  Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over 5 years. The degree to which outpatient providers are controlling risk factors has not been fully described.
  
  
  METHODS
  We examined adherence to the Million Hearts clinical quality measures using The Guideline Advantage, a nationwide quality improvement program for outpatient care. Specifically, we determined the proportion of patients with (1) ischemic vascular disease who were prescribed an antiplatelet drug; (2) hypertension whose blood pressure was controlled; (3) diabetes mellitus whose most recent low-density lipoprotein cholesterol level was <100 mg/dL; and 4) a tobacco use screening and who received a smoking cessation intervention as needed.
  
  
  RESULTS
  From January 1, 2010, to March 31, 2012, there were 147,038 patients enrolled from 25 US practices. At the practice level, antiplatelet prescription ranged from 50.0% to 82.3% (median 71.9%, interquartile range [IQR] 66.7-82.1), hypertension control ranged from 48.6% to 75.3% (median 66.6%, IQR 60.1-70.9), hyperlipidemia control among patients with diabetes mellitus ranged from 53.3% to 100.0% (median 75.8%, IQR 65.8-83.0), and tobacco use screening and intervention ranged from 31.0% to 98.8% (median 79.8%, IQR 72.0-83.2). Black and people of color races were associated with a lower likelihood of blood pressure control and cholesterol control. Female gender was associated with a lower likelihood of antiplatelet prescription and cholesterol control.
  
  
  CONCLUSIONS
  Compliance with quality measures for the Million Hearts initiative varies widely and is notable for racial and gender disparities. Our findings identify multiple opportunities to improve the quality of cardiovascular prevention.
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: zubin.eapen@duke.edu.
authors.forename: Zubin J
authors.initials: ZJ
authors.lastname: Eapen
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: Ohio University Heritage College of Osteopathic Medicine, Athens, OH.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Shubrook
authors.affiliation: INTEGRIS Family Care Central, Oklahoma City, OK.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Bauman
authors.affiliation: Midwest Heart Specialists, Naperville, IL.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Bufalino
authors.affiliation: Veterans Affairs Boston Healthcare System and Brigham and Women's Hospital, Boston, MA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D020521:Stroke / Q000517:prevention & control*