Horiz. BCBS Quality Improvement Study

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) has initiated a quality improvement study to evaluate its members undergoing treatment for hyperlipidemia, a metabolic disorder characterized by high levels of fat and cholesterol in the blood. Hyperlipidemia is associated with a number of serious disorders including coronary heart disease.

The study results indicated that more than 70 percent of Horizon BCBSNJ patients were effectively managing their cholesterol levels through prescribed drug therapy. Horizon BCBSNJ will use these results to educate its physicians on the overall effectiveness of Horizon BCBSNJ’s current drug therapy and identify some of the potential improvements that can be made in the management of hyperlipidemia.

Saira A. Jan, M.S., Pharm.D., associate director of pharmacy services at Horizon BCBSNJ and associate professor at Rutgers State University of New Jersey, managed and conducted the study.

The study involved a retrospective examination of randomly selected medical charts of patients who were identified through claims data as undergoing treatment with a lipid-lowering agent. The reviews of 436 patients’ charts were conducted by the Total Therapeutic Management Corporation (TTM), an independent outcomes research consulting company located in Georgia. Variables analyzed included patient demographics, cardiovascular disease risk factors, cardiovascular monitoring, cholesterol lowering medications and outcomes.

“The hyperlipidemia quality improvement program helps ensure that our patients are receiving the maximum benefit from prescribed drug therapy,” said Dr. Jan.

Physician education was also incorporated in the study to help doctors make appropriate, cost-effective, therapeutic decisions in ensuring better outcomes for their patients. Physicians participating in the study received a profiling report summarizing their patients’ most recent low-density lipoproteins value.

Study results revealed:

A majority of patients, 51.2 percent either had existing coronary heart disease or risk equivalents.

Of the patients with low-density lipoproteins, 71.8 percent met treatment goals.

Approximately 15 percent of patients did not have documentation to follow-up assessment of goal attainment.

The most prevalent diseases with side effects included hypertension, coronary heart disease and diabetes.

A round table meeting involving physicians included in the study was held to discuss the results, guidelines and therapeutic treatment options. A second round table meeting is scheduled and a physician newsletter and fax program will also be sent to providers in 2002.

The study results also indicated that prescription drug utilization and follow-up documentation could improve. Through educational interventions provided to physicians, Horizon BCBSNJ will strive to improve the quality of treatment provided to its hyperlipidemic members.

Article continues below

---

advertisement

---

Author: Horizon BCBSNJ