Correlates of Repeat Lipid Testing in Patients With Coronary Heart Disease | Cardiology | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Committee on Quality of Health Care in America, Institute of Medicine.  Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
Smith  M, Saunders  R, Stuckhardt  L, McGinnis  JM, eds.  Committee on the Learning Health Care System in America, Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: National Academies Press; 2012.
Drozda  J  Jr, Messer  JV, Spertus  J,  et al.  ACCF/AHA/AMA-PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association–Physician Consortium for Performance Improvement.  Circulation. 2011;124(2):248-704.Google ScholarCrossref
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.  Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).  JAMA. 2001;285(19):2486-2497.Google ScholarCrossref
Grundy  SM, Cleeman  JI, Merz  CN,  et al; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association.  Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.  Circulation. 2004;110(2):227-239.PubMedGoogle ScholarCrossref
Virani  SS, Woodard  LD, Landrum  CR,  et al.  Institutional, provider, and patient correlates of low-density lipoprotein and non–high-density lipoprotein cholesterol goal attainment according to the Adult Treatment Panel III guidelines.  Am Heart J. 2011;161(6):1140-1146.PubMedGoogle ScholarCrossref
Virani  SS, Woodard  LD, Chitwood  SS,  et al.  Frequency and correlates of treatment intensification for elevated cholesterol levels in patients with cardiovascular disease.  Am Heart J. 2011;162(4):725-732.Google ScholarCrossref
Solberg  LI, Engebretson  KI, Sperl-Hillen  JM, Hroscikoski  MC, O’Connor  PJ.  Are claims data accurate enough to identify patients for performance measures or quality improvement? the case of diabetes, heart disease, and depression.  Am J Med Qual. 2006;21(4):238-245.PubMedGoogle ScholarCrossref
Ho  PM, Bryson  CL, Rumsfeld  JS.  Medication adherence: its importance in cardiovascular outcomes.  Circulation. 2009;119(23):3028-3035.PubMedGoogle ScholarCrossref
Osterberg  L, Blaschke  T.  Adherence to medication.  N Engl J Med. 2005;353(5):487-497.PubMedGoogle ScholarCrossref
Petersen  LA, Woodard  LD, Henderson  LM, Urech  TH, Pietz  K.  Will hypertension performance measures used for pay-for-performance programs penalize those who care for medically complex patients?  Circulation. 2009;119(23):2978-2985.PubMedGoogle ScholarCrossref
Petersen  LA, Pietz  K, Woodard  LD, Byrne  M.  Comparison of the predictive validity of diagnosis-based risk adjusters for clinical outcomes.  Med Care. 2005;43(1):61-67.PubMedGoogle Scholar
Woodard  LD, Landrum  CR, Urech  TH, Wang  D, Virani  SS, Petersen  LA.  Impact of clinical complexity on the quality of diabetes care.  Am J Manag Care. 2012;18(9):508-514.PubMedGoogle Scholar
Virani  SS, Wang  D, Woodard  LD,  et al.  Non–high-density lipoprotein cholesterol reporting and goal attainment in primary care.  J Clin Lipidol. 2012;6(6):545-552.PubMedGoogle ScholarCrossref
US Department of Veterans Affairs.  VIReC Research User Guide: VHA Decision Support System Clinical National Data Extracts.2nd ed. Hines, IL: VA Information Resource Center (VIReC), Health Services Research and Development Service, US Dept of Veterans Affairs; 2009.
Hayward  RA, Krumholz  HM.  Three reasons to abandon low-density lipoprotein targets: an open letter to the Adult Treatment Panel IV of the National Institutes of Health.  Circ Cardiovasc Qual Outcomes. 2012;5(1):2-5.PubMedGoogle ScholarCrossref
Hayward  RA, Hofer  TP, Vijan  S.  Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem.  Ann Intern Med. 2006;145(7):520-530.PubMedGoogle ScholarCrossref
Choudhry  NK, Avorn  J, Glynn  RJ,  et al; Post–Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) Trial.  Full coverage for preventive medications after myocardial infarction.  N Engl J Med. 2011;365(22):2088-2097.PubMedGoogle ScholarCrossref
Glasziou  PP, Irwig  L, Heritier  S, Simes  RJ, Tonkin  A; LIPID Study Investigators.  Monitoring cholesterol levels: measurement error or true change?  Ann Intern Med. 2008;148(9):656-661.PubMedGoogle ScholarCrossref
Original Investigation
Health Care Reform
August 12/26, 2013

Correlates of Repeat Lipid Testing in Patients With Coronary Heart Disease

Author Affiliations
  • 1Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
  • 2Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
  • 3Veterans Affairs Great Lakes Health Care System, Westchester, Illinois
JAMA Intern Med. 2013;173(15):1439-1444. doi:10.1001/jamainternmed.2013.8198

Importance  Understanding the frequency and correlates of redundant lipid testing could identify areas for quality improvement initiatives aimed at improving the efficiency of cholesterol care in patients with coronary heart disease (CHD).

Objective  To determine the frequency and correlates of repeat lipid testing in patients with CHD who attained low-density lipoprotein cholesterol (LDL-C) goals and received no treatment intensification.

Design, Setting, and Participants  We assessed the proportion of patients with LDL-C levels of less than 100 mg/dL and no intensification of lipid-lowering therapy who underwent repeat lipid testing during an 11-month follow-up period. We performed logistic regression analyses to evaluate facility, provider, and patient characteristics associated with repeat testing. In total, we analyzed 35 191 patients with CHD in a Veterans Affairs network of 7 medical centers with associated community-based outpatient clinics.

Main Outcomes and Measures  Frequency and correlates of repeat lipid testing in patients having CHD with LDL-C levels of less than 100 mg/dL and no further treatment intensification with lipid-lowering therapies.

Results  Of 27 947 patients with LDL-C levels of less than 100 mg/dL, 9200 (32.9%) had additional lipid assessments without treatment intensification during the following 11 months (12 686 total additional panels; mean, 1.38 additional panel per patient). Adjusting for facility-level clustering, patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95% CI, 1.13-1.30), higher illness burden (OR, 1.39; 95% CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95% CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95% CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95% CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95% CI, 0.71-0.80) were less likely to undergo repeat testing. Among 13 114 patients who met the optional LDL-C target level of less than 70 mg/dL, repeat lipid testing was performed in 8177 (62.4% of those with LDL-C levels of <70 mg/dL) during 11 follow-up months.

Conclusions and Relevance  One-third of patients having CHD with LDL-C levels at goal underwent repeat lipid panels. Our results highlight areas for quality improvement initiatives to reduce redundant lipid testing. These efforts would be more important if the forthcoming cholesterol guidelines adopt a medication dose–based approach in place of the current treat-to-target approach.