title: Statin Use and Its Facility-Level Variation in Patients With Diabetes: Insight From the Veterans Affairs National Database.
abstract: We sought to determine use of any and at least moderate-intensity statin therapy in a national sample of patients with diabetes mellitus (DM), with the hypothesis that nationwide frequency and facility-level variation in statin therapy are suboptimal. We sampled patients with DM age 40 to 75 years receiving primary care between October 1, 2012, and September 30, 2013, at 130 parent facilities and associated community-based outpatient clinics in the Veterans Affairs Health Care System. We examined frequency and facility-level variation in use of any or at least moderate-intensity statin therapy (mean daily dose associated with ≥30% low-density lipoprotein cholesterol lowering). In 911 444 patients with DM, 68.3% and 58.4% were receiving any and moderate- to high-intensity statin therapy, respectively. Patients receiving statin had higher burden of cardiovascular disease, were more likely to be on nonstatin lipid-lowering therapy and to receive care at a teaching facility, and had more frequent primary-care visits. Median facility-level uses of any and at least moderate-intensity statin therapy were 68.7% (interquartile range, 65.9%-70.8%) and 58.6% (interquartile range, 55.8%-61.4%), respectively. After adjusting for several patient-related and some facility-related characteristics, the median rate ratios for any and moderate- to high-intensity statin therapy were 1.20 (95% confidence interval: 1.18-1.22) and 1.29 (95% confidence interval: 1.24-1.33) respectively, indicating 20% to 29% variation in statin use between 2 identical patients receiving care at 2 random facilities. Statin use was suboptimal in a national sample of patients with DM with modest facility-level variation, likely indicating differences in statin-prescribing patterns.
authors.affiliation: Saint Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Missouri.
authors.forename: Yashashwi
authors.initials: Y
authors.lastname: Pokharel
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.|Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas.|Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Akeroyd
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.|Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas.|Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ramsey
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Hira
authors.affiliation: Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas.|Department of Medicine, Baylor College of Medicine, Houston, Texas.|Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas.|Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.|Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Tina
authors.initials: T
authors.lastname: Shah
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.|Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas.|Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: LeChauncy D
authors.initials: LD
authors.lastname: Woodard
authors.affiliation: Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida.|University of Florida College of Medicine, Gainesville, Florida.
authors.forename: David E
authors.initials: DE
authors.lastname: Winchester
authors.affiliation: Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas.|Department of Medicine, Baylor College of Medicine, Houston, Texas.|Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.|Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas.|Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
authors.affiliation: Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas.|Department of Medicine, Baylor College of Medicine, Houston, Texas.|Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas.|Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas.|Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000639:trends*; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions; D050171:Dyslipidemias / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends*; D058014:Veterans Health / Q000639:trends*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors