Association between statin use and lipid status in quality improvement initiatives: statin use, a potential surrogate?

Bojadzievski, Trajko MD
Schaefer, Eric MS
Hollenbeak, Chris S PhD
Gabbay, Robert A MD PhD

Clinical Fellow in Endocrinology, Diabetes and Metabolism, Penn State Hershey Diabetes Institute, Division of Endocrinology, Diabetes and Metabolism, Penn State College of Medicine, Hershey, Pennsylvania, USA
Biostatistician, Public Health Sciences – Biostatistics Division, Penn State College of Medicine, Hershey, Pennsylvania, USA
Director, Graduate Education, Department of Public Health Sciences, Division of Health Services Research, Penn State College of Medicine, Hershey, Pennsylvania, USA
Director, Penn State Hershey Diabetes Institute, Penn State College of Medicine, Hershey, Pennsylvania, USA

FUNDING

None.

ETHICAL APPROVAL

The study was approved by the Penn State Human Subjects Protection Office.

PEER REVIEW

Not commissioned; externally peer-reviewed.

CONFLICTS OF INTEREST

The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript.

ADDRESS FOR CORRESPONDENCE

Dr Robert A Gabbay, Penn State Hershey Diabetes Institute, Division of Endocrinology, Diabetes and Metabolism, Penn State College of Medicine, 500 University Drive Hershey, Pennsylvania, USA. Tel: 717–531 8395; email: [email protected]

Received 06 May 2012

Accepted 20 September 2012

Quality in Primary Care 20(6):p 401-407, 2012.

Objective

To test the association between statin use and low-density-lipoprotein (LDL)-cholesterol control in outpatient community practices undergoing quality improvement efforts in diabetes care.

Design

A retrospective observational study of primary care practices that underwent efforts at improving the quality of diabetes care. Each practice provided an electronic registry-based monthly report of the percentage of patients with LDL <130 mg/dl (3.4 mmol/l), LDL <100 mg/dl (2.6 mmol/l) and statin use.

Setting

Primary care practices in Pennsylvania focused on improving diabetes care by implementing the Chronic Care Model in urban, suburban and rural regions.

Participants

Consisted of 109 primary care practices, academic practices and federal health centres. Practices typically saw patients from a mix of government-funded and commercial health plan carriers.

Results

There was a positive linear association between documented statin use and the percentage of patients with LDL <130 mg/dl (3.4 mmol/l) and LDL <100 mg/dl (2.6 mmol/l = goal for patients with diabetes). The correlation between statin use and LDL <130 was 0.50 (95% CI 0.41–0.64), and between statin use and the percentage of patients with LDL <100 was 0.47 (95% CI 0.29–0.58). Practices with 5% larger statin use had an expected 1.9% larger percentage of patients with LDL <130 (95% CI 1.4 –2.9%) and an expected 1.7% larger percentage of patients with LDL <100 (95% CI 0.9–2.3%).

Conclusion

An association exists between statin use and LDL control in the real world of primary care practices undergoing quality improvement. Additional studies are necessary to ultimately test the validity of statin use as a process measure and/or surrogate for LDL-cholesterol control.