SL Pineros, HSR&D, VA Puget Sound Health Care System; AB Sales, HSR&D, VA Puget Sound Health Care System; H Sun, University of Washington; NR Every, Cardiology Service, VA Puget Sound Health Care System; GV Martin, Cardiology Service, VA Puget Sound Health Care System; KL Sloan, Mental Health Division, VA Puget Sound Health Care System

Objectives: The purpose of this paper is to describe the Lipid Measurement and Mangement System (LMMS) Study pilot project, a non-randomized trial of three clinical interventions to improve guideline compliance in VISN 20, the Veterans Administration’s Northwest Network. The primary objective of the research team was to record activities and monitor the effects of organized activities designed to change patterns of practice affecting lipid profiles of patients with known ischemic heart disease. A second objective of this study was to use the LMMS to measure process and outcome variables to evaluate the impact of the interventions on patient care in VISN 20.

Methods: This manuscript describes intervention activities included as quality improvement projects within the LMMS Study in VISN 20. Each facility in VISN 20 was classified into one of four categories of interventions: Lipid Clinic, Audit/Feedback, Point of Care Reminder, or No Intervention. We report on two process measures (LDL measurement and lipid lowering treatment) and two outcome measures (mean LDL and mean HDL values) to assess the impact of the interventions on risk of secondary complications in patients with known IHD. The LMMS was used to monitor the effect of interventions at periodic intervals for a 12 month period between June 30, 1999 and June 30, 2000. Data were extracted using a relational data warehouse that has been created for the eight facilities in VISN 20. Patients who were clearly receiving ongoing and consistent care through one of the eight VA facilities in VISN 20 throughout the period of observation and were identified as having CHD were included in the analysis.

Results: For proportion of IHD patients tested for serum LDL, Point of Care Reminders and Audit/Feedback were both significantly different from No Intervention and Lipid Clinics as well as from each other. For proportion of IHD patients receiving lipid lowering treatment and mean LDL value changes between pre-intervention and intervention period, the results were not significant when compared to ‘No intervention’. During the intervention period, Point of Care Reminder intervention sites had a significant increase in mean HDL values compared to the other intervention sites and ‘No intervention’. No other differences were significant.

Conclusions: This was a brief, rapid impact pilot intervention evaluation, designed to examine the effects of interventions selected by the facilities themselves. A strong effect occurred in increasing lipid measurement in the Audit and Feedback intervention and the Point of Care reminder intervention facilities. Point of Care reminder intervention facilities also showed a significant increase in mean HDL values. The strength of the intervention did not, however, persist to lipid management.

Impact: 1. It is difficult to determine a clear trend in the four outcome variables that suggests that one intervention is dominant over the others, or over the No Intervention group. Instead, it appears that the only strong effect occurred in increasing lipid measurement in the Audit and Feedback intervention and the Point of Care reminder intervention facilities.

2. The four interventions studied were not strong enough, however, to cause an increase in lipid management.

3. Providers were found to be very enthusiastic about their interventions at the onset but busy clinic schedules and lack of financial incentives proved to be insurmountable barriers to increasing and improving intervention activities.