title: Low-density lipoprotein-cholesterol (LDL-C) greater than 100 mg/dL as a quality indicator: locating risk in person, place and time.
abstract: OBJECTIVE
  Achieving control over elevated lipid parameters, particularly low-density lipoprotein (LDL)-cholesterol, is an acknowledged quality indicator in primary care. The Centers for Disease Control and Prevention (CDC)'s model for investigation of outbreaks (person-place-time) can be applied to the analysis of quality indicators.
  
  
  METHODS
  A sample of 322 family medicine patients for whom lipid levels were ordered was extracted. LDL > 100 mg/dL was cross-tabulated by personal characteristics [age group, gender, body mass index (BMI), diagnoses], month (time) and ordering department (place).
  
  
  RESULTS
  Age (except one age category), gender, time and location were not related to LDL > 100 mg/dL after adjustment for covariates. All levels of BMI above normal elevated the risk of LDL > 100 mg/dL [BMI 25-29.9: odds ratio (OR) = 3.41, confidence interval (CI) = 1.61-7.23, P = 0.0014; BMI 30-34.9: OR = 2.93, CI = 1.28-6.70, P = 0.0109; BMI ≥ 35: OR = 2.75, CI = 1.19-6.37, P = 0.0181]. Patients with coronary artery disease (CAD) and diabetes mellitus (DM) were at reduced risk for LDL > 100 mg/dL (CAD: OR = 0.47, CI = 0.24-0.91, P = 0.0254; DM: OR = 0.28, CI = 0.14-0.55, P = 0.0002).
  
  
  CONCLUSIONS
  An outbreak investigation model is useful for analysing variations in this quality indicator. Patients with higher BMI and those not diagnosed with CAD or DM type I/II may be considered for intensified lipid lowering using quality improvement efforts. These might include counselling for lifestyle changes or medication therapy depending upon their calculated cardiac risk.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Rohrer
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Yusuf C
authors.initials: YC
authors.lastname: Doganer
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Merry
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Angstman
authors.affiliation: Sports Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Erickson
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Furst
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL
keywords: cholesterol; family medicine; lipid parameters; outbreak investigations; primary care; quality improvement