title: Physicians' behavior following changes in LDL cholesterol target goals.
abstract: BACKGROUND
  In 01/2011 Clalit Health Services (CHS), changed the LDL-Cholesterol target definitions in its quality indicators program, from a universal target to values stratified by risk assessment based on ATP III criteria. The objective of this study is to evaluate the effect of this change on achievement of LDL-C targets and on physicians' prescriptions of statins.
  
  
  METHODS
  A descriptive study based on administrative dataset 06/2010-06/2012.
  
  
  METHODS
  
  
  
  METHODS
  CHS, The largest health maintenance organization in Israel that insures above 4,000,000 beneficiaries.
  
  
  METHODS
  PATIENTS who had been in the same risk group throughout the study period.
  
  
  METHODS
  Attainment of targets for LDL-C and purchases of statins prior to, and following, implementation of the guidelines in the CHS quality indicators program.
  
  
  RESULTS
  433,662 patients remained in the same risk groups throughout the study period; 55.8% were women; the average age was 53.0 ± 10.3 years; 63.9%, 13.4%, and 22.7% were at low, medium, and high risk respectively. After implementation, the proportion of patients reaching LDL-C targets increased in all risk groups: from 58.6% to 61.6%, from 55.1% to 61.1%, and from 44.5% to 49.0%, in low, medium, and high risk groups respectively (p < 0.001). The proportion of patients treated with potent statins increased in all risk groups; from 3.4% to 5.6%, from 6.7% to 10.3%, and from 14.5% to 20.3% respectively (p < 0.001).
  
  
  CONCLUSIONS
  The risk stratification approach as a basis for the quality indicators program was implemented and better achievement of target LDL-C levels ensued. We suggest that implementation of quality indicators that are consistent with the current literature can lead to improvements that exceeds temporal trends.
authors.affiliation: Chief Physician Office, Central Headquarter, Clalit Health Services, Tel Aviv, Israel ; Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
authors.affiliation: Chief Physician Office, Central Headquarter, Clalit Health Services, Tel Aviv, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Bitterman
authors.affiliation: Chief Physician Office, Central Headquarter, Clalit Health Services, Tel Aviv, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Comaneshter
authors.affiliation: Chief Physician Office, Central Headquarter, Clalit Health Services, Tel Aviv, Israel ; Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Arnon D
authors.initials: AD
authors.lastname: Cohen
keywords: Clinical guidelines; Hypercholesterolemia; Quality indicators; Statins