LDL Program

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As one of its improvement projects, the Vanderbilt University Medical Center developed a process to reduce low-density lipoprotein (LDL) rates to meet the Adult Treatment Panel guideline of less than 100 mg/dL. The center produced a treatment protocol that improved the way the team monitors and determines proper medications for patients in order to optimize LDL control.

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LDL Program

Vanderbilt University Medical Center

For one of its improvement projects, the Vanderbilt University Medical Center developed a process to reduce low-density lipoprotein (LDL) rates to meet the Adult Treatment Panel (ATP III) guideline of less than 100 mg/dL.

To accomplish this goal, the team produced a treatment protocol (PowerPoint® File, 470 KB; Text Version) by medication type rather than specific medication. This approach improved the way the team monitors and determines proper medications for patients in order to optimize LDL control.

Incorporating a collaborative team approach that included the patient, physician, nurse, clinical assistant, data manager, and pharmacist, the project used the ATP III guidelines for statin use as the protocol.

After identifying a group of 120 diabetic patients with an average LDL rate of 126.7, the team developed the following process:

• The pharmacist reviews the patient's medical record, determines a therapy recommendation, and informs the primary care provider of the plan.
• After the provider approves or amends the plan, the team advises the patient (by phone or letter) of the recommended plan.
• The team prepares a lab sheet for the patient and sends him or her educational materials.
• After the pharmacist calls in the new prescription, the team follows up with the patient and updates the patient's medical record.

The team monitored progress for 8 months and saw a decrease in the baseline LDL rate (126.7) to 110 mg/dL, with 40 of the original 120 patients at the 100 mg/dL goal.

Because there is no certified diabetes educator on this team, the service cannot be billed. However, the team estimates that it only cost about $4 to 6 per patient for this augmentation service, not counting overhead, supplies, etc.

The team identified the following success factors in their approach:

• The medical staff agreed to the goals.
• Other clinics helped coordinate the plan once they were contacted.
• The pharmacist completed the first two steps in the electronic medical record.
• The staff used phone calls and letters to reach the patient, and the letter was added to the patient's chart.
• Used two medicines.

The Vanderbilt University Medical Center team believes the results will attract a payer willing to fund the continuation of the process, and the faculty is very willing to support it. The plan included simple changes that cost patients about an additional $45 a month on average.

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