TY - JOUR
T1 - Current quality of cardiovascular prevention for million hearts
T2 - An analysis of 147,038 outpatients from the guideline advantage
AU - Eapen, Zubin J.
AU - Liang, Li
AU - Shubrook, Jay H.
AU - Bauman, Mary A.
AU - Bufalino, Vincent J.
AU - Bhatt, Deepak L.
AU - Peterson, Eric D.
AU - Hernandez, Adrian F.
N1 - Funding Information:
Evaluating quality of ambulatory care across multiple practices is possible via The Guideline Advantage, a national quality improvement program supported by the AHA, the American Diabetes Association, and the American Cancer Society. Compliance with clinical quality measures for the Million Hearts initiative varies widely and is notable for gender and racial disparities in the quality of outpatient care. Our findings identify multiple opportunities to improve the quality of cardiovascular prevention.
Funding Information:
JH Shubrook: Dr Shubrook reports research support from Sanofi Aventis and advisory board funding from Eli Lilly.
Funding Information:
Sources of funding: This work was supported with funding from the American Heart Association in partnership with the American Cancer Society and the American Diabetes Association . This work was also supported in part by grant number U19HS021092 from the Agency for Healthcare Research and Quality . The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.
Funding Information:
MA Bauman: Dr Bauman reports editorial board funding from Medical Economics.
Funding Information:
ZJ Eapen: Dr Eapen reports advisory board funding from Novartis and honoraria from Janssen.
PY - 2014/9
Y1 - 2014/9
N2 - Background Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over 5 years. The degree to which outpatient providers are controlling risk factors has not been fully described. Methods We examined adherence to the Million Hearts clinical quality measures using The Guideline Advantage, a nationwide quality improvement program for outpatient care. Specifically, we determined the proportion of patients with (1) ischemic vascular disease who were prescribed an antiplatelet drug; (2) hypertension whose blood pressure was controlled; (3) diabetes mellitus whose most recent low-density lipoprotein cholesterol level was <100 mg/dL; and 4) a tobacco use screening and who received a smoking cessation intervention as needed. Results From January 1, 2010, to March 31, 2012, there were 147,038 patients enrolled from 25 US practices. At the practice level, antiplatelet prescription ranged from 50.0% to 82.3% (median 71.9%, interquartile range [IQR] 66.7-82.1), hypertension control ranged from 48.6% to 75.3% (median 66.6%, IQR 60.1-70.9), hyperlipidemia control among patients with diabetes mellitus ranged from 53.3% to 100.0% (median 75.8%, IQR 65.8-83.0), and tobacco use screening and intervention ranged from 31.0% to 98.8% (median 79.8%, IQR 72.0-83.2). Black and people of color races were associated with a lower likelihood of blood pressure control and cholesterol control. Female gender was associated with a lower likelihood of antiplatelet prescription and cholesterol control. Conclusions Compliance with quality measures for the Million Hearts initiative varies widely and is notable for racial and gender disparities. Our findings identify multiple opportunities to improve the quality of cardiovascular prevention.
AB - Background Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over 5 years. The degree to which outpatient providers are controlling risk factors has not been fully described. Methods We examined adherence to the Million Hearts clinical quality measures using The Guideline Advantage, a nationwide quality improvement program for outpatient care. Specifically, we determined the proportion of patients with (1) ischemic vascular disease who were prescribed an antiplatelet drug; (2) hypertension whose blood pressure was controlled; (3) diabetes mellitus whose most recent low-density lipoprotein cholesterol level was <100 mg/dL; and 4) a tobacco use screening and who received a smoking cessation intervention as needed. Results From January 1, 2010, to March 31, 2012, there were 147,038 patients enrolled from 25 US practices. At the practice level, antiplatelet prescription ranged from 50.0% to 82.3% (median 71.9%, interquartile range [IQR] 66.7-82.1), hypertension control ranged from 48.6% to 75.3% (median 66.6%, IQR 60.1-70.9), hyperlipidemia control among patients with diabetes mellitus ranged from 53.3% to 100.0% (median 75.8%, IQR 65.8-83.0), and tobacco use screening and intervention ranged from 31.0% to 98.8% (median 79.8%, IQR 72.0-83.2). Black and people of color races were associated with a lower likelihood of blood pressure control and cholesterol control. Female gender was associated with a lower likelihood of antiplatelet prescription and cholesterol control. Conclusions Compliance with quality measures for the Million Hearts initiative varies widely and is notable for racial and gender disparities. Our findings identify multiple opportunities to improve the quality of cardiovascular prevention.
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U2 - 10.1016/j.ahj.2014.06.007
DO - 10.1016/j.ahj.2014.06.007
M3 - Article
C2 - 25173553
AN - SCOPUS:84908499240
SN - 0002-8703
VL - 168
SP - 398
EP - 404
JO - American heart journal
JF - American heart journal
IS - 3
ER -