Influence of the demographic factors and clinical variation on the low-density lipoprotein level among low income patients with cardiovascular conditions in San Diego County

Background: The San Diego Low Income Health Program (LIHP) uses one of the nine defined Healthcare Effectiveness Data and Information Set (HEDIS) measures to determine the clinical effectiveness of cholesterol management for patients with cardiovascular conditions. The percent compliance rate for the measure has been very low since the program was first implemented in July 2011.;Study Questions: To determine whether all patients with cardiovascular conditions have been screened for lipids during the four quarters (Jul 2012-Jun 2013) analyzed in the study, and identify which demographic and clinical factors that were associated with Low- Density Lipoprotein, LDL>100 mg/dL.;Methods: Using LIHP claims data from July 1, 2012-June 30, 2013; all enrollees with cardiovascular conditions were identified by International Classification of Diseases, ICD-9 and Current Procedural Terminology, CPT codes. The LIHP claims data were merged with the LDL data set that is collected separately from the LIHP claims data. Percent test rates for all providers and patient demographic characteristics such gender, race/ethnicity, and age were used as the independent variables to test the association between LDL and those demographic and clinical characteristics. Results: Not all the patients with cardiovascular conditions were screened during the four quarters analyzed for the study.;Results from multiple logistic regression showed that percent LDL test was significantly associated with LDL above 100 mg/dL. For the gender variable, females showed 2.5 times more likelihood for LDL above 100 mg/dL. In race/ethnicity, non-white racial group showed 1.88 times as likely than white to have a bad LDL above 100 mg/dL. No significant association was found for the age variable.;Conclusion: The majority of LIHP patients were found to have had a cardiovascular condition have not been screened for lipids during the four quarters analyzed. Clinical variations such as percent test rate and demographic factors such as gender, and race/ethnicity were found to be some of the factors that determined whether LDL was above 100 mg/dL for the San Diego county LIHP patients with cardiovascular conditions.