Assessment of hypercholesterolemia control in a managed care organization

To determine the extent of achievement of goal low-density lipoprotein chol esterol (LDL) as defined by National Cholesterol Education Program-Adult Tr eatment Panel II (NCEP-ATP II) and American Diabetes Association (ADA) 2000 guidelines, we conducted a retrospective study by integrating data from me dical, laboratory, and pharmacy claims databases. Subjects were selected fr om a 232,000-member staff-model managed care organization consisting of 19 clinics in the Minneapolis-St. Paul, Minnesota, metropolitan area. A total of 124,971 members aged IS years and older, who had been continuously enrol led from July 1, 1996-June 6, 1998, were included. Outcome measures were th e extent of achievement of goal LDL as defined by NCEP-ATP II and the use o f antihyperlipidemic drugs for patients with and without diabetes at variou s levels of risk for coronary heart disease (CHD). Of 124,971 subjects, 653 8 had a history of CHD, 1523 of whom met their LDL goal. Of the population with CHD who did not achieve goal, 1141 (43%) missed by over 30 mg/dl; 621 (54%) of these patients were not receiving drug therapy A total of 17,267 h ad no history of CHD but had two or more risk factors; 3298 of these achiev ed their LDL goal. Of those who did not achieve goal, 1136 (35%) missed by over 30 mg/dl; 897 (79%) of these were not receiving drug therapy A total o f 6586 had a history of diabetes; 1004 and 2340 reached an LDL of 100 mg/dl or lower and less than 130 mg/dl, respectively Of those with diabetes who had an LDL greater than 100 mg/dl, 1276 (49%) missed their goal by over 30 mg/dl; 898 (70%) of these were not receiving drug therapy. Inadequate use o f pharmacologic agents plays a significant role in failure to achieve goal LDL for patients with CHD, without CHD, and with diabetes. Analysis of the data based on the new ADA guidelines for LDL demonstrates the need for cont inued vigilance. Finally, the successful merging of medical, laboratory and pharmacy claims databases provides a benchmark for other institutions.