Article: article from journal or magazin.
Treatment intensification and risk factor control: toward more clinically relevant quality measures.
Publication types: Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Validation Studies
Publication Status: ppublish
Publication Status: ppublish
BACKGROUND: Intensification of pharmacotherapy in persons with poorly controlled chronic conditions has been proposed as a clinically meaningful process measure of quality. OBJECTIVE: To validate measures of treatment intensification by evaluating their associations with subsequent control in hypertension, hyperlipidemia, and diabetes mellitus across 35 medical facility populations in Kaiser Permanente, Northern California. DESIGN: Hierarchical analyses of associations of improvements in facility-level treatment intensification rates from 2001 to 2003 with patient-level risk factor levels at the end of 2003. PATIENTS: Members (515,072 and 626,130; age >20 years) with hypertension, hyperlipidemia, and/or diabetes mellitus in 2001 and 2003, respectively. MEASUREMENTS: Treatment intensification for each risk factor defined as an increase in number of drug classes prescribed, of dosage for at least 1 drug, or switching to a drug from another class within 3 months of observed poor risk factor control. RESULTS: Facility-level improvements in treatment intensification rates between 2001 and 2003 were strongly associated with greater likelihood of being in control at the end of 2003 (P < or = 0.05 for each risk factor) after adjustment for patient- and facility-level covariates. Compared with facility rankings based solely on control, addition of percentages of poorly controlled patients who received treatment intensification changed 2003 rankings substantially: 14%, 51%, and 29% of the facilities changed ranks by 5 or more positions for hypertension, hyperlipidemia, and diabetes, respectively. CONCLUSIONS: Treatment intensification is tightly linked to improved control. Thus, it deserves consideration as a process measure for motivating quality improvement and possibly for measuring clinical performance.
Aged, Antihypertensive Agents/administration & dosage, Antihypertensive Agents/therapeutic use, Antilipemic Agents/administration & dosage, Antilipemic Agents/therapeutic use, California, Cardiovascular Diseases/prevention & control, Chronic Disease/drug therapy, Diabetes Mellitus/drug therapy, Drug Therapy/methods, Drug Therapy/standards, Female, Humans, Hyperlipidemias/drug therapy, Hypertension/drug therapy, Hypoglycemic Agents/administration & dosage, Hypoglycemic Agents/therapeutic use, Male, Managed Care Programs, Middle Aged, Outcome and Process Assessment (Health Care), Quality Indicators, Health Care/standards, Risk Factors
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