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Relationship between cardiovascular risk and lipid testing in one health care system: a retrospective cohort study
- Source :
- BMC Health Services Research, BMC health services research, vol 15, iss 1
- Publication Year :
- 2015
- Publisher :
- BioMed Central, 2015.
-
Abstract
- Background The US Preventive Services Taskforce (USPSTF) recommends routine lipid screening beginning age 35 for men [1]. For women age 20 and older, as well as men age 20–34, screening is recommended if cardiovascular risk factors are present. Prior research has focused on underutilization but not overuse of lipid testing. The objective is to document over- and under-use of lipid testing in an insured population of persons at low, moderate and high cardiovascular disease (CVD) risk for persons not already on statins. Methods The study is a retrospective cohort study that included all adults without prior CVD who were continuously enrolled in a large integrated healthcare system from 2005 to 2010. Measures included lipid test frequency extracted from administrative data and Framingham cardiovascular risk equations applied using electronic medical record data. Five year lipid testing patterns were examined by age, sex and CVD risk. Generalized linear models were used to estimate the relative risk for over testing associated with patient characteristics. Results Among males and females for whom testing is not recommended, 35.8 % and 61.5 % received at least one lipid test in the prior 5 years and 8.4 % and 24.4 % had two or more. Over-testing was associated with age, race, comorbidity, primary care use and neighborhood income. Among individuals at moderate and high-risk (not already treated with statins) and for whom screening is recommended, between 21.4 % and 25.1 % of individuals received no screening in the prior 5 years. Conclusions Based on USPSTF lipid screening recommendations, this study documents substantial over-testing among individuals with low CVD risk and under-testing among individuals with moderate to high-risk not already on statins. Opportunity exists to better focus lipid screening efforts appropriate to CVD risk.
- Subjects :
- Male
Aging
Alternative medicine
Disease
Comorbidity
Cardiovascular
Health informatics
Health administration
Risk Factors
Medicine
Mass Screening
education.field_of_study
Health Policy
Nursing research
Health Services
Middle Aged
Lipids
3. Good health
Heart Disease
Cardiovascular Diseases
Public Health and Health Services
Health Policy & Services
Female
Research Article
Adult
Washington
medicine.medical_specialty
Population
Nursing
Cholesterol testing
Library and Information Studies
Clinical Research
Humans
education
Aged
Retrospective Studies
Primary Health Care
business.industry
Prevention
Public health
Quality of care
Retrospective cohort study
Cardiovascular disease risk
Good Health and Well Being
Emergency medicine
Organizational Case Studies
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Subjects
Details
- Language :
- English
- ISSN :
- 14726963
- Volume :
- 15
- Database :
- OpenAIRE
- Journal :
- BMC Health Services Research
- Accession number :
- edsair.doi.dedup.....46ad1a81efb8c8375472d976d3ee87dd