Clinical Practice Gaps Related to Lipid Management in Patients With Type 2 DiabetesAmy Larkin, PharmD;

Colleen S. Healy, MA; Anne Le, PharmD; Medscape Education, New York, NY

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Introduction

Methods

Research has identified clinical practice gaps in the management of diabetes, which include suboptimal assessment and management of low-density lipoprotein cholesterol (LDL-C) levels as well as other lipid parameters.1,2,3,4 As part of a quality improvement, continuing medical education (CME)-based initiative on type 2 diabetes (T2D) management, lipid management was assessed in this population. The objective of this

study was to conduct a baseline assessment survey to detect clinical practice gaps related to lipid management in patients with T2D. In addition, CME will be used as an intervention in a quality improvement (QI) initiative to address the identified practice gaps; post-education effects on physician performance and patient metrics will be measured and reported at a specified date in 2016.

Primary Care Provider Participant Selection:

A total of 60 PCPs (MD, DO, NP, PA) were identified using a method to determine providers with the greatest need for T2D education.

• PCPs must have had at least 20 unique patients with T2D in 2013 to be considered.

• Of these PCPs, CareHere identified, by provider, the number of patients who have T2D and a 2013 HbA1c >9% (uncontrolled T2D).

• The 60 providers with the greatest proportion of patients who met these criteria were selected for participation, with the assumption that these providers demonstrate need for education, as they have the largest proportion of patients with uncontrolled T2D.

Inclusion Criteria:

A sample of patient charts was selected at random from among the population of patients who met the following criteria:

• T2D diagnosis

• 18 to 75 years of age

• HbA1c between 7% and 9%

• At least 1 visit with the provider between May 1, 2013 and April 30, 2014

Data Collection:

Chart data were extracted for the time period May 1, 2013 to April 31, 2014 to provide 1 full year of patient chart information from the 10 patients per provider.

Quality Measures:

In addition to demographic data, other data were collected and assessed based on measures and standards set forth by the National Committee for Quality Assurance (NCQA), American Medical Association–Physician Consortium for Performance Improvement (AMA–PCPI), and American Diabetes Association (ADA), and included:

• Percentage of patients with LDL-C <70mg/dL and <100mg/dL,

• Percentage of patients with non-HDL-C <100mg/dL and <130mg/dL,

• Percentage of patients with documentation of statin use

Patient Sample Demographics

• Age: 54 years (Min = 26, Max = 74, SD = 8.19)

• Sex: 47% were female

• Duration of T2D: 6.2 years (Min = 0, Max = 44, SD = 7.2)

• Comorbidities: heart disease (14%) and peripheral neuropathy (11%)

• Obesity: 74%

LDL-CL

• 21% had LDL-C <70 mg/dL

• 55% had LDL-C <100 mg/dL

• Patients with T2D and cardiovascular disease (CVD)

o 35% had LDL-C <70 mg/dL

o 65% had LDL-C <100 mg/dL

Statin utilization

• Overall: 63% o Among patients with statin use, 71% were

moderate-intensity, 16% high-intensity, 9% low-intensity, and 4% had unknown statin therapy (due to missing medication dosage documentation)

• Patients with T2D and CVD: 80% statin use

As part of a QI initiative, a baseline chart review was performed for 10 patients from each of 60 primary care physicians (PCPs) (total of 600 patients) that included data related to lipid parameters and statin use.

References

• This baseline assessment identified significant clinical practice gaps related to lipid management in patients with T2D

o Almost half of patients were not achieving LDL-C <100 mg/dl

o More than one-third of patients with T2D were not currently prescribed a statin

• Online CME will be used as a means to close these practice gaps and improve care for patients with T2D

o Results related to educational impact on above quality measures will be available in 2016

• Implications:

o The overall goal of this quality initiative is to improve the ability of physicians and other HCPs to provide optimal T2D treatment.

o The effectiveness of the health system-focused initiative design has implications for the scalability of the model to other healthcare provider systems.

Disclosure

The authors have nothing to disclose.

Source of Support

For more information contact: Amy Larkin PharmD, Director of Clinical Strategy, Medscape, LLC alarkin@medscape.net

Notes

This CME-certified activity was supported by an independent educational grant from AstraZeneca Pharmaceuticals LP.

Conclusion

1. Garber AJ, Abrahamson MJ, Barzilay JI, et al. American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement—executive summary. Endocr Pract. 2013;19:536-557.

2. Inzucchi SE, Bergenstal RM, Buse JB, et al; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364-1379.

3. National Committee for Quality Assurance (NCQA). The state of healthcare quality 2012. October 2012. http://www.ncqa.org/Portals/0/State%20of%20Health%20Care/2012/SOHC%20Report%20Web.pdf Accessed April 17, 2015.

4. Peters Al. Closing the gaps in comprehensive diabetes care: Performance Improvement. June 29, 2012. Metrics Report for Performance Improvement CME. Medscape Education Diabetes & Endocrinology. Data on file.

21%

55%

20%

52%

63%

35%

65%

31%

59%

80%

0%

20%

40%

60%

80%

100%

LDL-C < 70mg/dL

LDL-C < 100mg/dL

non-HDL-C < 100mg/dL

non-HDL-C < 130mg/dL

Statin Use

All Patients Patients with Heart Disease

Adherence to T2D Quality Measures (Lipids)

Results

IRB-approved Protocol

Baseline Chart Review (n = 60 PCPs/600 patients)

Direction to 1 to 5 Medscape online CME modules

3-month follow-up random chart review for provider

performance change assessment

9-month follow-up matched chart review for patient-level

change assessment

Clinician-to-clinician education with chart review

benchmarking

60 CareHere Providers