Study Suggests Quality Initiatives Needed to Reduce Repeat Lipid Testing


Newswise — An analysis of patients with coronary heart disease (CHD) who attained low-density lipoprotein cholesterol (LDL-C) goals with no treatment intensification suggests that about one-third of them underwent repeat testing, according to a report published by JAMA Internal Medicine, a JAMA Network publication.

The authors note in the study background that the frequency and correlates of repeat lipid testing in patients with CHD who have already achieved Adult Treatment Panel III guideline-recommended LDL-C treatment targets and received no treatment intensification are unknown. The guideline-recommended LDL-C target is less than 100 mg/dL.

“In these patients, repeat lipid testing may represent health resource overuse and possibly waste of health care resources,” according to the study.

Salim S. Virani, M.D., Ph.D., of the Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, Houston, Texas, and colleagues analyzed a total of 35,191 patients with CHD in a VA network of seven medical centers. Of 27,947 patients with LDL-C levels less than 100 mg/dL, 9,200 (32.9 percent) had additional lipid tests without treatment intensification during the following 11 months, the study results indicate.

According to the authors, “Collectively, these 9,200 patients with CHD had a total of 12,686 additional lipid panels performed. With a mean lipid panel cost of $16.08...this is equivalent to $203,990 in annual costs for one VA network and does not take into account the cost of the patient’s time to undergo lipid testing and the cost of the provider’s time to manage these results and notify the patient.”

“Our results highlight areas to target for future quality improvement initiatives aimed at reducing redundant lipid testing in patients with CHD,” the study concludes. (JAMA Intern Med. Published online July 1, 2013. doi:10.1001/jamainternmed.2013.8198. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor’s Note: Authors made conflict of interest and funding disclosures. This work was also supported by a Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence grant and by a Veterans Affairs contract. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Physician Performance Measurement

In a related commentary, Joseph P. Drozda, Jr., M.D., Center for Innovative Care, Chesterfield, Mo., writes: “The investigators conclude that this represents redundant testing and is a target for quality improvement efforts and believe this would be even more important if the forthcoming Adult Treatment Panel IV guidelines call for a medication dose-based approach to lipid management as opposed to the current treat-to-target approach.”

“This well-conceived study on a large clinical database, which has the advantage of containing pharmacy data for use in tracking medication adherence, delivers an important message regarding a type of waste that is likely widespread in health care and that goes under the radar because it involves a low-cost test,” Drozda continues.

“However, it is precisely these low-cost, high-volume tests and procedures that need to be addressed if significant savings from reduction of waste are to be realized,” Drozda concludes.(JAMA Intern Med. Published online July 1, 2013. doi:10.1001/jamainternmed.2013.6808. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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