Abstract 16: Addressing Gaps In Cholesterol Management In Primary Cardiovascular Prevention In A Resident Run Internal Medicine Clinic: A Mixed Method Approach

Abstract

Background: Provider and system level barriers can delay timely initiation of statin therapy in primary atherosclerotic cardiovascular disease (ASCVD) prevention. A simple, pragmatic and scalable quality improvement (QI) approach is needed to address these gaps. Methods: We describe methods and preliminary results of a QI initiative in a resident run internal medicine clinic in Cayuga Medical Center (total 19 residents, 5 attendings, ~200 patients seen/month with 10% no shows). First, we assessed rates of lipids tested and statin use in 40-75 years old patients without ASCVD. Second, we performed a focus group discussion (FGD) among residents, attendings and clinic leadership to understand barriers for statin use. Third, we outlined key actionable items informed by FGD. Finally, we will assess the impact of the intervention. Findings: We report baseline data in 325 consecutive patients (Table). Mean age was 55.2 years (50.2% women), 50.6% did not have lipids checked and only 17.5% were on statin therapy in the preceding 3 years. Three major themes from FGD were: lack of automated ASCVD score reporting in electronic medical record (EMR), insufficient clinic time and follow up visits. Subsequently, we adopted automated ASCVD risk reporting in EMR and telemedicine follow up to address identified gaps and associated downstream impact, which is currently ongoing. Conclusion: Using mixed-method approach, we describe an implementation strategy to address gaps in cholesterol management in primary prevention patients in a resident run clinic. If effective, this strategy can be a model for other clinics.