Cardiovascular disease, including heart attack and stroke, is the leading cause of death in the United States. Prevention of heart disease and atherosclerosis, the narrowing or blocking of arteries, includes controlling lipid levels in the blood. Lipids are measured based on LDL cholesterol levels, and lipid management may include the use of lipid-lowering medications such as statin drugs. Partners HealthCare is working to develop new ways to help patients manage lipid levels and make lifestyle changes to help prevent the onset of cardiovascular disease.
What is our approach to managing quality for such large populations of patients?
Partners eCare, our electronic health record, allows us to collect health information and develop standardized lists, known as “registries”, to track lab results, blood pressure readings, and other relevant clinical information – all in a single location for an entire population of patients. Our population health coordinators work with our clinical team to review the data from these patient registries regularly, so they can reach out to patients who would benefit from updated lab testing, blood pressure monitoring, procedures, or medication therapy.
What are we measuring and why?
Lowering lipid levels is a critical way to save lives by preventing the complications of cardiovascular disease.
How does this measure differ from traditional metrics that rely on claims (billing) data?
We use our electronic health record (EHR) data to identify patients with cardiovascular disease, using information entered by clinicians into the general patient problem list and notes from individual office encounters – including whether these patients are treated with the appropriate dose of statin medications. This approach more accurately identifies patients with this condition, enabling clinicians to make better clinical decisions about patient care.
Lipid Control
We track the number of patients with cardiovascular disease who have controlled their lipids based on LDL cholesterol levels or the use of appropriate lipid-lowering medications (statins). This can translate directly into prevention of heart attack and stroke.
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Read more details about this measure.
**Due to an issue capturing data from the electronic medical record for the data period ending in the first week of October of 2017, a data period from one week prior was used for comparison with 2018 data.
| Total Eligible Patients |
|---|
| Year |
BWPO |
CRMA |
MGPO |
NWPHO |
NSHS |
PHS |
| 2017 |
8,821 |
Not Available* |
15,962 |
5,773 |
Not Available* |
30,556 |
| 2018 |
9,027 |
4,866 |
17,422 |
6,002 |
9,349 |
46,666 |
*2017 data for North Shore Health System and Charles River Medical Associates could not be collected until they upgraded to Partners’ new electronic medical record and had 1 full year of data.
Measure Details
Data Periods: October 2016 - September 2017 and October 2017 - September 2018
Partners HealthCare Data Source: Electronic Health Record (EHR) System
Denominator: Adult patients (age≥18 years) diagnosed with cardiovascular disease defined as 1) a diagnosis present on the electronic problem list, or 2) a clinician-entered diagnosis during an office visit in the most recent 12 months, or 3) presence of a billing diagnosis (claims data) in the last 12 months.
Numerator: The number of patients with 1) a LDL cholesterol level less than 100 mg/dL measured in the last 12 months, or 2) a prescription for a high dose of a statin medication.
Measure Details
We have improved cardiovascular disease lipid control measurement by 1) including all adults 18 years and older with cardiovascular disease (no longer excluding younger women with heart disease); 2) allowing physicians to document lipid results from outside of our system; and 3) accounting for whether a patient is already being treated with maximal medication therapy.
Permanent exclusions allow our clinicians to identify patients for whom we are not actively managing high lipid levels. We remove these patients from the denominator. This includes patients who are deceased, no longer receiving care from our primary care physicians, or those incorrectly diagnosed with cardiovascular disease.
Permanent exceptions allow our clinicians to identify patients correctly diagnosed with cardiovascular disease but for whom lipid control is no longer clinically appropriate. We count these patients as contributing positively to the numerator. This includes patients with a terminal illness or advanced dementia.
Temporary exceptions allow our clinicians to identify patients correctly diagnosed with cardiovascular disease, but for whom lipid control may be temporarily not clinically appropriate. We count these patients as contributing positively to the numerator for 12 months following this designation. This includes patients who have a competing comorbidity, are compliant with maximum tolerated therapy, are intolerant to medical therapy or have a contraindication, are declining medication, or are not able to afford medication.
