scholarly journals First Steps: Exploring Use of a Prospective, Office-Based Registry as the Foundation for Quality Improvement in Cardiology Training

2013 ◽  
Vol 5 (4) ◽  
pp. 694-699 ◽  
Author(s):  
Melissa A. Frederick ◽  
Tejwant Singh ◽  
Sule Salami ◽  
William J. Oetgen ◽  
Howard S. Rosman
Keyword(s):  
Quality Improvement ◽  
System Performance ◽  
Teaching Practice ◽  
Medical Center ◽  
National Registry ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Performance Achievement ◽  
Positive Effects ◽  
Outpatient Practice

Abstract Background Teaching practice-based learning and improvement and systems-based practice are challenging. Cardiology fellows at St John Hospital & Medical Center participate in a national registry of outpatient cardiology care. Objective We assessed the use of the registry, hypothesizing that it could serve as an effective foundation for studying ambulatory care, identifying gaps in care, and planning interventions to advance competence in practice-based learning and improvement and systems-based practice. Methods Starting in 2009, trainees prospectively entered data for ambulatory cardiac patients into the PINNACLE Registry database where compliance with 28 performance measures was calculated and reported quarterly. Fellows met with the program director individually and in groups to identify performance gaps and to develop and implement plans for quality improvement. Cardiology fellows were surveyed annually to assess this process. Results Through March 2012, the fellows had completed 2400 patient visits. Participation was feasible because it was cost neutral, with data form completion averaging 5 minutes. It was acceptable, with most fellows describing positive effects on practice-based learning and improvement without significant detriment to work flow. Performance achievement for drug therapies ranged from 69% (77 of 111) of the patients with atrial fibrillation receiving anticoagulation to 99% (486 of 489) of patients with coronary disease receiving lipid-lowering therapy. Gaps in system performance included low levels for diabetes screening (5%; 20 of 422) and lipid monitoring (10%; 58 of 573). Initial quality improvement projects addressed practice gaps with straightforward solutions. Improving system performance was more challenging. Conclusions Using a registry in cardiology trainees' outpatient practice is feasible, acceptable, and valuable. It allows for planning and studying the effects of quality improvement projects.

Abstract P320: Gender Disparities in Low Density Lipoprotein (LDL) Control for Secondary Prevention Among Patients with Coronary Heart Disease (CHD): Does Having a Caregiver Matter?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Gmerice Hammond ◽  
Heidi Mochari-Greenberger ◽  
Ming Liao ◽  
Lori Mosca
Keyword(s):  
Secondary Prevention ◽  
Gender Gap ◽  
Medical Center ◽  
Academic Medical Center ◽  
Density Lipoprotein ◽  
Gender Disparities ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Multivariable Adjustment ◽  
Statin Use

Background: Despite the proven benefits of lipid lowering therapy for the prevention of recurrent CHD, research has consistently shown that women are less likely than men to be at established LDL targets. The reasons for the gender gap remain elusive. The purpose of this study was to test the hypothesis that having a caregiver is independently associated with adherence to Adult Treatment Panel (ATP) III LDL goals for secondary prevention, and to determine if the association varies by gender. Methods: We studied 2190 consecutive patients admitted to the cardiac service of an academic medical center as part of the NHLBI sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O) Study (93% participation rate). Patients with CHD or equivalent, and a documented LDL within 12 months of admission were included in this analysis (58% white, 66% male, mean age 67 yrs). Caregiver status was assessed by a standardized interviewer-assisted questionnaire and was classified as either paid (nurse/home aide) or informal (family member/friend). Lipid levels and statin use were obtained from a hospital-based informatics system and medical chart review. ATP III targets were classified as target (LDL<100 mg/dL) and aggressive target (LDL<70 mg/dL). The associations between caregiving and LDL were assessed using chi square statistics, overall and stratified by gender. Multivariable regression was used to adjust for confounders (age, marital status, race, gender, health insurance, statin use, comorbidities). Results: Males with CHD were more likely than females with CHD to be at target LDL <100 [79% (1149/1446) vs 69% (515/744) respectively; p=0.0001], and at LDL<70 [48% (688/1446) vs 36% (271/744); p<0.0001]. The prevalence of caregiving overall was 40% (N= 879/2190; 13% paid; 27% informal only), and did not differ by gender. Having an informal caregiver was significantly associated with LDL<70 (OR=1.35; 95%CI=1.07-1.70), and this remained significant after multivariable adjustment for confounders (OR=1.25; 95% CI=1.00-1.56). The association between caregiving and LDL<100 did not reach significance (OR=1.20; 95% CI=0.95-1.51). In stratified analysis, men with an informal caregiver were more likely than men without a caregiver to have an LDL<70 (OR=1.35; 95%CI=1.07-1.70); this remained significant after multivariable adjustment for confounders, including statin use (OR=1.37; 95%CI=1.04-1.80). The relation between caregiving and LDL control was not significant among women. Conclusion: Men with CHD were more likely to be at ATP III targets LDL <70 and <100 mg/dL than women with CHD. Having an informal caregiver was a significant predictor of being at aggressive target LDL <70mg/dL among men but not among women, even after adjustment for confounders. The potential role of caregiving as a novel contributor to gender disparities in LDL control deserves further study.

scholarly journals Meeting Resident Scholarly Activity Requirements Through a Longitudinal Quality Improvement Curriculum

2015 ◽  
Vol 7 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Madeline Simasek ◽  
Stephanie L. Ballard ◽  
Phillip Phelps ◽  
Rowena Pingul-Ravano ◽  
N. Randall Kolb ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Family Medicine ◽  
Literature Review ◽  
Work Group ◽  
Medical Center ◽  
Care Program ◽  
Scholarly Activity ◽  
University Of Pittsburgh ◽  
Outpatient Practice ◽  
The University

Abstract Background Quality improvement (QI) skills are learned during residency, yet there are few reports of the scholarly activity outcomes of a QI curriculum in a primary care program. Intervention We examined whether scholarly activity can result from a longitudinal, experiential QI curriculum that involves residents, clinic staff, and faculty. Methods The University of Pittsburgh Medical Center Shadyside Family Medicine Residency implemented a required longitudinal outpatient practice improvement rotation (LOPIR) curriculum in 2005. The rotation format includes weekly multidisciplinary work group meetings alternating with resident presentations delivered to the entire program. Residents present the results of a literature review and provide 2 interim project updates to the residency. A completed individual project is required for residency graduation, with project results presented at Residency Research Day. Scholarly activity outcomes of the curriculum were analyzed using descriptive statistics. Results As of 2014, 60 residents completed 3 years of the LOPIR curriculum. All residents satisfied the 2014 Accreditation Council for Graduate Medical Education (ACGME) scholarly activity and QI requirements with a literature review presentation in postgraduate year 2, and the presentation of a completed QI project at Residency Research Day. Residents have delivered 83 local presentations, 13 state/regional presentations, and 2 national presentations. Residents received 7 awards for QI posters, as well as 3 grants totaling $21,639. The educational program required no additional curriculum time, few resources, and was acceptable to residents, faculty, and staff. Conclusions LOPIR is an effective way to meet and exceed the 2014 ACGME scholarly activity requirements for family medicine residents.

Quality of lipid-lowering therapy in outpatient practice: RECVAS Register data

2016 ◽  
Vol 19 (1) ◽  
pp. 9 ◽  
Author(s):  
A. V. Zagrebelnyi ◽  
S. Yu. Martsevich ◽  
M. M. Lukyanov ◽  
A. N. Vorobyev ◽  
K. A. Moseichuk ◽  
...  
Keyword(s):  
Register Data ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Outpatient Practice

scholarly journals Lipid Clinic is an Efficacious Model of Preventive Medicine

2021 ◽  
Vol 17 (1) ◽  
pp. 4-10
Author(s):  
A. V. Blokhina ◽  
A. I. Ershova ◽  
A. N. Meshkov ◽  
A. S. Limonova ◽  
V. I. Mikhailina ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Preventive Medicine ◽  
Medical Center ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Medical Care System ◽  
Lipid Clinic ◽  
Lowering Therapy ◽  
Target Values ◽  
Very High

Aim. To characterize patients accessing lipid clinic and assess the efficiency of treatment in a specialized medical center.Material and methods. A retrospective analysis of the surviving medical records of outpatients who visited the lipid clinic of the National Research Center for Therapy and Preventive Medicine (Moscow, Russia) in 2011-2019 (n=675) was carried out. Cardiovascular risk (CVR) and target lipoproteins levels were evaluated in accordance with actual guidelines for the diagnostics and correction of dyslipidemias.Results. The mediana of lipid clinic patients age was 57 [46;65] years. Female persons attend lipid clinic more often (61.5%). 48.5% of patients had low density lipoprotein cholesterol (LDL-c) >4.9 mmol/L, 7.7% had triglycerides level >5.5 mmol/L. Most of the patients were diagnosed with type IIa hyperlipidemia (44,1%) or type IIb (28,0%). Inherited impaired lipid metabolism was diagnosed in 27.7% individuals. 12.7% of the patients had familial hypercholesterolemia, 57.4% – had secondary causes of impaired lipid metabolism. More than half of the patients (52.4%) had low or moderate CVR, 28.1% had a very high CVR. High or very high CVR individuals revisited the lipid clinic more often than people with lower risk (68.2% vs. 35.4%). Revisiting patients (25.4%) reached LDL-c targets more often (33.3% of very high CVR patients; 45.5% of moderate-risk people) than in ordinary outpatient practice. High-intensity statin therapy was recommended for 32% of patients, and combined lipid-lowering therapy – for 14.8%. Among very high CVR individuals, combined lipid-lowering therapy was prescribed for 38.5%. Given the lipid-lowering therapy prescribed in the lipid clinic, LDL-с<1.8 mmol/L and<1.5 mmol/L will be achieved at 40.7% and 32.9% of patients with very high СVR.Conclusion. Lipid clinic is an important part of the medical care system for long-term follow-up of patients with impaired lipid metabolism, and it is more efficient in achieving target values of lipids and correcting risk factors in comparison with the primary medical service.

scholarly journals RELATIONSHIP OF BRAIN NATRIURETIC PEPTIDE WITH SERUM LIPIDS AND BODY MASS INDEX IN HEALTHY ADULT MALES

2010 ◽  
Vol 17 (02) ◽  
pp. 274-278
Author(s):  
MEH JABEEN ◽  
Shah Murad ◽  
MOHAMMAD FURQAN ◽  
Zulfiqar-ul- Hassan ◽  
MOHSIN TURAB ◽  
...  
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Healthy Adult ◽  
Task Force ◽  
Medical Center ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Adult Males ◽  
Relationship Of ◽  
Apparently Healthy

Prevalence of morbid obesity has increased dramatically world wide during past three decades. BNP a cardiac lipolytic hormone is found to be decreased in obese hypertensive and heart failure patients. Increasing values of BMI are associated with dyslipidemia. Objective: To find out the relationship of BNP with increasing values of BMI and individual serum lipid fractions in apparently healthy adult males. Study Design: Observational, cross-sectional study. Setting: Department of Physiology at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. Material & Methods: Study included 85 adult males, aged between 20-60 years. All were nonsmokers, non- diabetic, having no other chronic illness and not taking any lipid lowering therapy. Study participants were evaluated for lipid profile and divided into three groups for the calculated BMI values according to WHO and International Obesity Task Force. Brain NatriureticPeptide was assayed by AxSym technology. Results: Brain Natriuretic Peptide developed a negative correlation with BMI, total and LDLcholesterol and a positive relation with HDL-cholesterol and triglycerides. Conclusions: This study concluded that Brain Natriuretic Peptide is negatively related with increasing values of BMI and degree of dyslipidemia in apparently healthy adult males.

scholarly journals Utilization and adherence to guideline-recommended lipid-lowering therapy at an academic medical center

2017 ◽  
Vol 37 (4) ◽  
pp. 276-281 ◽  
Author(s):  
Khalid A. Alburikan ◽  
Rayah M. Asiri ◽  
Abduallah M. Alhammad ◽  
Amer A. Abuelizz ◽  
Ghada A. Bawazeer ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Academic Medical

scholarly journals Improved Triglycerides and Insulin Sensitivity with 3 Months of Acipimox in Human Immunodeficiency Virus-infected Patients with Hypertriglyceridemia

2006 ◽  
Vol 91 (11) ◽  
pp. 4438-4444 ◽  
Author(s):  
Colleen Hadigan ◽  
James Liebau ◽  
Martin Torriani ◽  
Rebecca Andersen ◽  
Steven Grinspoon
Keyword(s):  
Insulin Sensitivity ◽  
Medical Center ◽  
Controlled Trial ◽  
Academic Medical Center ◽  
Fat Distribution ◽  
Lipid Lowering ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Lipid Lowering Therapy ◽  
Men And Women

Abstract Context: Metabolic abnormalities such as hypertriglyceridemia remain a challenge for optimizing long-term health in HIV-infected patients. Objective: Elevation of free fatty acids (FFAs) may contribute to hyperlipidemia and insulin resistance in HIV. We evaluated the efficacy and safety of chronic inhibition of lipolysis in HIV-infected men and women with hypertrigyceridemia. We hypothesized that acipimox would lead to significant reductions in triglycerides and improved insulin sensitivity, compared with placebo. Design: A 3-month, randomized, double-blind, controlled trial of acipimox (250 mg thrice daily) vs. placebo was conducted in 23 HIV-infected men and women with hypertriglyceridemia (&gt;150 mg/dl), abnormal fat distribution, and no current lipid-lowering therapy. The primary outcome variable was triglyceride concentration, and insulin sensitivity measured by hyperinsulinemic euglycemic clamp was a secondary outcome. Setting: The study was conducted at an academic medical center. Results: Acipimox resulted in significant reductions in FFAs [mean change −0.38 (0.06) vs. 0.08 (0.06) mEq/liter with placebo, −68 vs. +17% change from mean baseline, P &lt; 0.0001], decreased rates of lipolysis (P &lt; 0.0001), and a median triglyceride decrease from 238 mg/dl at baseline to 190 mg/dl, compared with an increase from 290 to 348 mg/dl in the placebo group (P = 0.01). Acipimox improved insulin sensitivity [acipimox +2.31 (0.74) vs. placebo −0.21 (0.90) mg glucose per kilogram lean body mass per minute, or +31 vs. −2% change from mean baseline values, P = 0.04]. Improvements in insulin sensitivity were significantly correlated with reductions in FFAs (r = −0.62, P = 0.003) and lipolysis (r = −0.59, P = 0.005). Conclusions: Acipimox resulted in significant sustained reductions in lipolysis, improved glucose homeostasis, and significant but modest reductions in triglycerides in HIV-infected individuals with abnormal fat distribution and hypertriglyceridemia. Improvement in overall metabolic profile with acipimox suggests a potential clinical utility for this agent that requires further investigation.

Development of a Pharmacist-Managed Lipid Clinic

2002 ◽  
Vol 36 (5) ◽  
pp. 892-904 ◽  
Author(s):  
Margaret A Cording ◽  
Emily B Engelbrecht-Zadvorny ◽  
B Jill Pettit ◽  
John H Eastham ◽  
Rheta Sandoval
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Treatment Algorithm ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Medical Clinic ◽  
Lipid Clinic ◽  
Lipid Panel ◽  
Intermediate Outcomes

OBJECTIVE: To describe the development of a pharmacist-managed lipid clinic within a primary care medical clinic and review its results after approximately 12 months of operation. METHODS: A pharmacist-managed lipid clinic was developed at Naval Medical Center San Diego. Administrative background, treatment algorithm development, operational issues, clinical activities, and barriers to the clinic are discussed. For intermediate outcomes, data from patients who had at least 1 intervention by the pharmacist and 1 follow-up lipid panel were analyzed for medication use, changes in lipid parameters, and percent reaching the low-density-lipoprotein (LDL) target goal. Modified National Cholesterol Education Program — Adult Treatment Panel II guidelines were used to determine the LDL goal. RESULTS: Following approximately 12 months of operation, the clinic received 204 referrals and consisted of 146 active patients. A brief study was conducted to assess clinical outcomes. Of 115 patients who were seen in the clinic and met inclusion criteria, 57% were receiving treatment with a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) and 17% were receiving fibrates; 17% of the patients were not receiving lipid-lowering medications. Relative to baseline, LDL cholesterol concentrations decreased 20%, high-density-lipoprotein cholesterol increased 11%, and triglycerides decreased 19%. Overall, LDL goals were reached in 77% of the patients. LDL goals were attained by 63%, 79%, and 93% of patients with targets of <100, <130, and <160 mg/dL, respectively. Results are compared with other studies regarding lipid goal attainment. CONCLUSIONS: A pharmacist-managed lipid clinic can be developed and integrated into a primary care medical clinic. Pharmacists can effectively manage lipid-lowering therapy, helping to achieve LDL goals.

scholarly journals LIPID-LOWERING THERAPY IN OUTPATIENT PRACTICE (ACCORDING TO THE ARGO-2 STUDY)

2016 ◽  
Vol 12 (2) ◽  
pp. 147-153 ◽  
Author(s):  
N. M. Akhmedzhanov ◽  
D. V. Nebieridze ◽  
A. S. Safaryan ◽  
V. A. Vygodin ◽  
A. Yu. Shuraev ◽  
...  
Keyword(s):  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Outpatient Practice

scholarly journals ANICHKOV study: the effect of combined hypotensive and lipid-lowering therapy on cardiovascular complications in patients of high and very high risk

2019 ◽  
Vol 91 (4) ◽  
pp. 90-98 ◽  
Author(s):  
I V Sergienko ◽  
A A Ansheles ◽  
O M Drapkina ◽  
N B Gornyakova ◽  
M Yu Zubareva ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Antihypertensive Drugs ◽  
Combined Therapy ◽  
Initial Dosage ◽  
Cardiovascular Complications ◽  
Lifestyle Changes ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
History Of ◽  
Outpatient Practice

Reducing the risk of cardiovascular complications include lifestyle changes, drug therapy for achieving target blood pressure levels, normalizing the lipid profile, and correcting other risk factors. Adherence to therapy is of particular role, especially in primary prevention, which determines the need to implement the concept of fixed combinations. Approximately 70% of patients with AH have elevated levels of total cholesterol (TCh) and LDL-C, which determines the feasibility of using a FC containing a statin with two antihypertensive drugs. Aim. The aim of the study was to assess cardiovascular risk in patients with elevated levels of total cholesterol and LDL-C and concomitant AH, a comparative analysis of adherence, efficacy and safety of various forms of combined therapy in outpatient practice, including promising lisinopril/amlodipine/rosuvastatin FC (Ekvamer®). Materials and methods. The ANICHKOV study included 702 patients in Moscow and the Moscow region over 18 years old with a cholesterol level ≥7.5 mmol/l and/or LDL-C ≥4.9 mmol/l from March 2017 to December 2018 based on 2 federal centers. According to the results of visit I, patients were prescribed with one of three therapy schemes. In the absence of AH, patients received scheme I (Mertenil® at initial dosage of 10 mg/day). When history of AH existed or AH detected at visit I, patients were randomized to scheme II (Ekvamer® 5/10/10 mg/day) or III (Mertenil® 10 mg/day + Ekvator® 5/10 mg/day). During the observation, the treatment scheme remained unchanged, however, if the target levels of LDL-C and/or BP were not reached, the doses could be increased. The analysis of the main effects of the prescribed therapy were carried out for 12 months, and the frequency of MACE (CVD, ACS, stroke, or hospitalization to perform PCI) was also evaluated Results and discussion. Following the visit I, scheme I was assigned to 390 patients (55.6%), scheme II - 190 (27.1%), scheme III - 122 (17.4%). In 147 patients (20.9%), TG level was >2.3 mmol/l, which required additional fenofibrate intake in a dose of 145 mg/day. Adherence level was 89.5%, including scheme I - 91.7%, scheme II - 90.5%, scheme III - only 81.8%. In general, among compliant patients (n = 590), the decrease in TCh level was 41.0%, LDL-C - 47.4%. 16.6% of patients reached target levels of LDL-C

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