Table 4.

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 CVDModerate Risk–DMAge 40 to 75 years with DM and ≥ 7.5% RiskModerate Risk–Primary PreventionAge 40-75 years with >10% Risk
High-Dose StatinAny StatinHigh-Dose StatinAny StatinHigh-Dose StatinAny Statin
Patient Factors
Patient age5-year difference1.08 (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 index1-unit difference1.16 (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 visits1-visit difference1.01 (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)
GenderFemale versus male0.56 (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)
RaceAsian versus white1.12 (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 white0.97 (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 white1.23 (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)
EthnicityHispanic versus non-Hispanic0.70 (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 typeMedicaid versus commercial0.68 (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 commercial0.93 (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 yearNo versus Yes1.18 (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 < 500.46 (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 residentAttending versus resident3.55 (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 typeCommunity 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. affiliate0.29 (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 locationRural versus urban0.20 (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 urban0.41 (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 EHR1-year difference1.15 (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 portal1-year difference1.22 (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 ordersNo versus Yes5.20 (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.