Premium
Low‐density lipoprotein‐cholesterol ( LDL ‐ C ) greater than 100 mg/dL as a quality indicator: locating risk in person, place and time
Author(s) -
Rohrer James E.,
Doganer Yusuf C.,
Merry Stephen P.,
Angstman Kurt B.,
Erickson Jacob L.,
Furst Joseph W.
Publication year - 2015
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12378
Subject(s) - body mass index , medicine , odds ratio , confidence interval , cholesterol , diabetes mellitus , endocrinology
Rationale, aims and objectives Achieving control over elevated lipid parameters, particularly low‐density lipoprotein ( LDL )‐cholesterol, is an acknowledged quality indicator in primary care. The C enters for D isease C ontrol and P revention ( 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). Conclusion 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.