Associations between Patient, Clinician and Practice Characteristics, and Uptake of ACC/AHA Cholesterol Guideline [(Odds Ratio, (95% CI)] Using Electronic Health Record Patient Data from 2013 to 2016
Highest RiskAge 40 to 75 years with CVD | Moderate Risk–DMAge 40 to 75 years with DM and ≥ 7.5% Risk | Moderate Risk–Primary PreventionAge 40-75 years with > 10% Risk | |||||
---|---|---|---|---|---|---|---|
High-Dose Statin | Any Statin | High-Dose Statin | Any Statin | High-Dose Statin | Any Statin | ||
Patient Factors | |||||||
Patient age | 5-year difference | 1.08 (1.04, 1.11) | 1.25 (1.21, 1.28) | 0.99 (0.94, 1.03) | 1.10 (1.06, 1.14) | 1.04 (1.00, 1.07) | 1.07 (1.03, 1.10) |
Comorbidity index | 1-unit difference | 1.16 (1.13, 1.20) | 1.13 (1.10, 1.16) | 1.21 (1.16, 1.26) | 1.08 (1.04, 1.12) | 1.19 (1.15, 1.22) | 1.19 (1.16, 1.23) |
No. of visits | 1-visit difference | 1.01 (0.99, 1.02) | 1.03 (1.02, 1.05) | 1.00 (0.98, 1.03) | 1.01 (0.99, 1.02) | 1.02 (1.01, 1.03) | 1.02 (1.00, 1.03) |
Gender | Female versus male | 0.56 (0.50, 0.63) | 0.52 (0.47, 0.58) | 0.81 (0.70, 0.94) | 0.94 (0.84, 1.05) | 0.87 (0.81, 0.95) | 0.88 (0.81, 0.96) |
Race | Asian versus white | 1.12 (0.84, 1.49) | 1.36 (1.01, 1.82) | 0.71 (0.53, 0.97) | 0.98 (0.74, 1.30) | 1.02 (0.86, 1.22) | 1.12 (0.94, 1.34) |
Black versus white | 0.97 (0.85, 1.11) | 1.15 (1.02, 1.30) | 0.81 (0.68, 0.96) | 0.98 (0.74, 1.30) | 0.91 (0.82, 1.01) | 0.95 (0.86, 1.06) | |
Other versus white | 1.23 (0.92, 1.63) | 0.98 (0.75, 1.29) | 1.03 (0.75, 1.43) | 0.91 (0.78, 1.04) | 0.90 (0.75, 1.08) | 0.90 (0.74, 1.08) | |
Ethnicity | Hispanic versus non-Hispanic | 0.70 (0.46, 1.07) | 1.17 (0.83, 1.64) | 0.51 (0.30, 0.85) | 1.00 (0.70, 1.43) | 1.36 (1.05, 1.76) | 1.41 (1.09. 1.84) |
Insurance type | Medicaid versus commercial | 0.68 (0.53, 0.88) | 0.87 (0.71, 1.05) | 0.67 (0.47, 0.95) | 0.88 (0.70, 1.10) | 0.84 (0.70, 1.01) | 0.88 (0.73, 1.05) |
Medicare versus commercial | 0.93 (0.79, 1.09) | 0.95 (0.83, 1.09) | 1.15 (0.94, 1.41) | 0.91 (0.78, 1.06) | 0.96 (0.86, 1.07) | 0.98 (0.88, 1.09) | |
Wellness visit during year | No versus Yes | 1.18 (1.03, 1.36) | 1.20 (1.06, 1.36) | 1.07 (0.89, 1.27) | 1.13 (0.97, 1.31) | 1.20 (1.09, 1.32) | 1.21 (1.10, 1.33) |
Clinician factors | |||||||
Clinician age, years | > 50 versus < 50 | 0.46 (0.40, 0.52) | 1.18 (1.05, 1.34) | 0.43 (0.36, 0.51) | 0.67 (0.61, 0.74) | 1.22 (1.09, 1.36) | 1.16 (1.04, 1.29) |
Attending versus resident | Attending versus resident | 3.55 (1.32, 9.58) | 2.51 (1.33, 3.48) | 1.71 (0.70, 4.17) | 2.38 (1.42, 3.99) | 2.44 (1.63, 3.65) | 2.45 (1.67, 3.59) |
Practice factors | |||||||
Practice type | Community health centers versus univ. affiliate | <0.10 (<0.10, <0.10) | 0.15 (0.13, 0.17) | <0.10 (<0.10, <0.10) | 0.28 (0.25, 0.31) | 0.25 (0.22, 0.27) | 0.26 (0.24, 0.28) |
Private versus univ. affiliate | 0.29 (0.26, 0.32) | 0.32 (0.29, 0.34) | 0.24 (0.21, 0.28) | 0.34 (0.31, 0.36) | 0.44 (0.41, 0.46) | 0.42 (0.39, 0.44) | |
Practice location | Rural versus urban | 0.20 (0.15, 0.26) | 0.45 (0.40, 0.51) | 0.15 (0.10, 0.22) | 0.55 (0.49, 0.63) | 0.61 (0.55, 0.68) | 0.63 (0.57, 0.70) |
Suburban versus urban | 0.41 (0.37, 0.46) | 0.43 (0.40, 0.46) | 0.34 (0.30, 0.39) | 0.42 (0.39, 0.45) | 0.60 (0.56, 0.64) | 0.58 (0.54, 0.61) | |
Year obtained EHR | 1-year difference | 1.15 (1.13, 1.17) | 1.16 (1.15, 1.17) | 1.17 (1.14, 1.19) | 1.14 (1.1, 1.15) | 1.08 (1.07, 1.09) | 1.09 (1.08, 1.10) |
Year obtained patient portal | 1-year difference | 1.22 (1.20, 1.25) | 1.23 (1.22, 1.25) | 1.25 (1.22, 1.28) | 1.22 (1.20, 1.23) | 1.13 (1.12, 1.14) | 1.14 (1.13, 1.16) |
Standing orders | No versus Yes | 5.20 (4.69, 5.77) | 4.70 (4.40, 5.01) | 5.68 (4.98, 6.48) | 3.57 (3.33, 3.83) | 2.67 (2.51, 2.83) | 2.74 (2.59, 2.90) |
EHR, electronic health record; ACC, American College of Cardiology; AHA, American Heart Association; CVD, cardiovascular disease; DM, diabetes mellitus; CI, confidence interval.
Italic value denotes statistically significant increase in guideline uptake compared to baseline.
Bold italic value denotes statistically significant decrease in guideline uptake compared to baseline.