Has Outpatient Care Controlled Heart Disease Risk Factors?

While focusing on improving the quality of inpatient hospital care is critical to give the patients the best and appropriate treatments, the quality of outpatient care is equally important to have a better control of heart disease risk factors including hypertension, diabetes, and smoking.

According to a study conducted by American researchers from Duke University in Durham and Edward Heart Hospital in Naperville, the control of heart disease risk factors varies widely among outpatient practices. The findings were presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2013.

Electronic health records of 115,737 patients in 18 primary care and cardiology practices participating in The Guideline Advantage were compared from January 1, 2010 to March 31, 2012.

Among the participants, 65,212 (56.3 percent) had hypertension, 67,826 (58.6 percent) had hyperlipidemia, 8,815 (7.6 percent) had diabetes mellitus, 3,073 (2.7 percent) had a history of a stroke or transient ischemic attack, and 23,624 (20.4 percent) had coronary artery disease.

Guideline Advantage, a collaboration of the American Cancer Society, American Diabetes Association and American Heart Association, is a nationwide quality improvement program for outpatient care. It collects data through existing electronic health records to report adherence to established guidelines with an aim to reducing risks for chronic diseases.

In the study, the researchers found that the percentage of people aged 18 through 85 years with hypertension under control (less than 140/90 mm Hg) ranged between 58.7 percent and 75.1 percent; the percentage of diabetic patients aged 18 through 75 years with hyperlipidemia control (bad low density lipoprotein cholesterol under 100 mg/dL) was between 53.8 percent and 100 percent; and the percentage of patients aged 18 years and older screened for smoking, and receiving a tobacco cessation intervention, was between 53.8 percent and 86.1 percent.

The findings did identified multiple opportunities for improving quality of outpatient care for cardiovascular prevention. Outpatient care providers can use them to compare their standard with their peers on nationally derived measures of quality and learn to improve in collaboration with others instead of alone.