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	James L. Holly, M.D.

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Your Life Your Health - SETMA’s Response to the Robert Wood Johnson Foundation: Part V The Primary Care Team Learning from Effective Ambulatory Practices

James L. Holly,M.D.

June 28, 2012

Your Life Your Health - The Examiner

(Editor’s Note: The Second section of information requested from SETMA by the Robert Wood Johnson Foundation for the Primary Care Team Project, Learning from Effective Ambulatory Practices concerned clinical performance measures both as to process, was a standard-of-care task performed, and to outcomes, did a standard-of-care task reflect that the patient was being treated well. This installment of SETMA’s response addresses cholesterol management)

This is the master template for the Lipid Disease Management Tool

The following is the master template in the Lipid Disease Management Tool built by SETMA. This is the link to the full tutorial: Lipids Tutorial

The Lipid Disease Management suite of templates allows all SETMA providers to bring to bear all of the information needed to provide excellent care for all patients. The treatment of cholesterol is important because of its contribution to cardiovascular risk. With this disease management tool, SETMA providers can calculate all twelve of the Framingham Cardiovascular and Cerebrovascular risk scores. In addition, SETMA has added five “What It” Scenarios for each of the scores. With this tool SETMA providers can show patients how a change in their habits will affect their health. This fulfills our goal of letting all patients know, “If you make a change, it will make a difference.” With the data collected SETMA providers can also let patients know if they have the Cardiometabolic Risk Syndrome, insulin resistance and how important it is to improve their cholesterol levels.

With the use of the disease management tool for Lipids, the following auditing and analytics can be done electronically.

In the above graph, the patients, we discover that patients whose cholesterol is treated to goal (those in the gold) are seen 5.3 times per year and those who are not treated to goal (those in purple) are seen only 2.8 times. This suggests that it may be possible to get more patients to goal by seeing them more often.

As we analyze the care of patients by “financial class,” i.e., by how their care is paid for, we see once again that our Medicare Advantage patients (HMO) are better treated than our Medicare Fee For Service (FFS) patients. This suggests that a financial barrier may exist with our FFS Medicare patients who have to pay to see us. Our HMO patients do not have to pay for office visits or blood tests. The better control of those who have no cost and the poor control of those who have cost suggest that at least in this population, the cost may be a barrier to the patient getting excellent care.

The above Ethnicity audit shows that we have not eliminated ethnic disparities in care of patients with dyslipidemia. We believe this may be cultural due to dietary choices and we are working on it.

There is no nationally endorsed quality metric set for lipids, therefore SETMA design this one and the audit bellows shows our performance.

The following is the audit of the Lipid Quality Metric set which allows us to see leverage points for improvement.

SETMA anticipates that a national standard of care for cholesterol auditing will be established and when it is, we will adopt it. At present, we have sent our audit to a number of quality metric development organizations and suggested that this be a starting point for developing of an auditing. All of the data in black in the above audit is to goal and all of that in “red” needs improvement.

There are national accepted standards for lipids such as that which is listed below in the National Committee for Quality Assurance (NCQA) includes cholesterol control in its standards for recognition of health care providers and organizations that perform excellently in the care of patients with diabetes. The LDL (Low Density Lipoprotein) is the “bad cholesterol. The below audit shows how SETMA providers perform on the control of LDL. All of SETMA providers and all SETMA clinics are recognized by NCQA for quality care in diabetes.

Other Articles in the SETMA’s Response to the Robert Wood Johnson Foundation Series

	SETMA’s Response to the Robert Wood Johnson Foundation: Part I - The Primary Care Team: Learning from Effective Ambulatory Practices SETMA’s Response to the Robert Wood Johnson Foundation: Part II - The Primary Care Team Learning from Effective Ambulatory Practices SETMA’s Response to the Robert Wood Johnson Foundation: Part III The Primary Care Team Learning from Effective Ambulatory Practices SETMA’s Response to the Robert Wood Johnson Foundation: Part IV The Primary Care Team Learning from Effective Ambulatory Practices

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