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 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)
Insurance type	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)
Practice type	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)
Practice location	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.