Background: Effective therapies exist for reducing mortality in persons with coronary heart disease (CHD), but they remain underused.
Objective: To report the design and baseline results of a quality improvement project designed to increase the use of hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors, beta-adrenergic blocking agents, and angiotensin-converting enzyme (ACE) inhibitors in patients with CHD in a network-model managed care setting.
Methods: Patients with CHD were identified by searching a claims database. Use of therapies was assessed by linkage with a pharmacy benefits database. A survey was mailed to primary care physicians to collect information related to attitudes and behavioral intentions regarding aggressive management of CHD. An intervention, consisting of a guideline summary, performance feedback, and medical chart reminders, was evaluated in a randomized, practice-based trial.
Results: Among 1189 patients with CHD, the median prevalence of receipt of HMG-CoA reductase inhibitors, beta-adrenergic blocking agents, and ACE inhibitors across practices at baseline (the first 3 months of 1999) was 50.0%, 35.0%, and 18.8%, respectively. Reported barriers included a perception that aggressive management of CHD is thought to be unimportant by support staff yet to require significant staff time. Aggressive management of CHD was perceived to incur non-reimbursable costs, to be unimportant in their patient population, to require a great deal of patient education and self-management, and to be limited because many patients do not adhere to therapy.
Conclusions: Opportunities exist for enhancing the quality of care provided to patients with CHD. Our experience to date supports the logistical feasibility of implementing network-level quality enhancement efforts in managed care networks.