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Clinical Goals and Performance Measures for Cholesterol Management in Secondary Prevention of Coronary Heart Disease
Thomas H. Lee, MD;
James I. Cleeman, MD;
Scott M. Grundy, MD;
Clayton Gillett;
Richard C. Pasternak, MD;
Joshua Seidman;
Cary Sennett, MD
JAMA. 2000;283:94-98.
Guidelines from the National Cholesterol Education Program (NCEP) recommend reduction of low-density lipoprotein cholesterol (LDL-C) to 100 mg/dL (2.59 mmol/L) or less in patients with established coronary heart disease (CHD). However, the National Committee for Quality Assurance (NCQA) is implementing a new performance measure as part of the Health Plan Employer and Data Information Set (HEDIS) that appears to endorse a different target. The new HEDIS measure will require managed care organizations seeking NCQA accreditation to measure and report the percentage of patients who have had major CHD events who achieve LDL-C levels less than 130 mg/dL (3.36 mmol/L) between 60 and 365 days after discharge. These different LDL-C thresholds emphasize the difference between a clinical goal for the management of individual patients ( 100 mg/dL) and a performance measure used to evaluate the care of a population of patients (<130 mg/dL). This article discusses the rationale for each threshold and explains the use of 2 different thresholds for these 2 purposes. Both the NCQA and NCEP expect that the new HEDIS measure will encourage managed care organizations to develop systems that improve secondary prevention of CHD.
Author Affiliations: Partners Community HealthCare Inc (Dr Lee), Brigham and Women's Hospital (Dr Lee), Harvard Medical School (Drs Lee and Pasternak), and Massachusetts General Hospital (Dr Pasternak), Boston; National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Cleeman); University of Texas Southwestern Medical Center, Dallas (Dr Grundy); Clinical Planning and Improvement, Group Health Cooperative, Seattle, Wash (Mr Gillett); and the National Committee for Quality Assurance, Washington, DC (Dr Sennett and Mr Seidman). Drs Lee and Sennett and Messrs Gillett and Seidman were selected by the National Committee for Quality Assurance and Drs Cleeman, Grundy, and Pasternak were selected by the National Cholesterol Education Program to participate in developing this article.
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