There was mixed evidence that provider-level computerized decision support improves outcomes .
There was more evidence in support of patient-level tools that provide connectivity to the healthcare system , as well as system-level interventions that involve data base monitoring and outreach by central ized care teams .
R and omized controlled trials show wide variability in the effects of HIT on lipid management outcomes .
Evidence suggests that multilevel HIT approaches that target not only providers but include patients and systems approaches will be needed to improve lipid treatment , adherence and quality
BACKGROUND Large gaps in lipid treatment and medication adherence persist in high-risk out patients in the United States .
Health information technology ( HIT ) is being applied to close quality gaps in chronic illness care , but its utility for lipid management has not been widely studied .
OBJECTIVE To perform a qualitative review of the impact of HIT interventions on lipid management processes of care ( screening or testing ; drug initiation , titration or adherence ; or referrals ) or clinical outcomes ( percent at low density lipoprotein cholesterol goal ; absolute lipid levels ; absolute risk scores ; or cardiac hospitalizations ) in out patients with coronary heart disease or at increased risk .
Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity.
CONTEXT Based on observational and interventional data for middle-aged cohorts ( aged 40 - 64 years ) , serum cholesterol level is known to be an established major risk factor for coronary heart disease ( CHD ) . However , findings for younger people are limited , and the value of detecting and treating hypercholesterolemia in younger adults is debated . OBJECTIVE To evaluate the long-term impact of unfavorable serum cholesterol levels on risk of death from CHD , cardiovascular disease ( CVD ) , and all causes . DESIGN , SETTING , AND PARTICIPANTS Three prospect i ve studies , from which were selected 3 cohorts of younger men with baseline serum cholesterol level measurements and no history of diabetes mellitus or myocardial infa rct ion . A total of 11,017 men aged 18 through 39 years screened in 1967 - 1973 for the Chicago Heart Association Detection Project in Industry ( CHA ) ; 1266 men aged 25 through 39 years examined in 1959 - 1963 in the Peoples Gas Company Study ( PG ) ; and 69,205 men aged 35 through 39 years screened in 1973 - 1975 for the Multiple Risk Factor Intervention Trial ( MRFIT ) . MAIN OUTCOME MEASURES Cause-specific mortality during 25 ( CHA ) , 34 ( PG ) , and 16 ( MRFIT ) years of follow-up ; mortality risks ; and estimated life expectancy in relation to baseline serum cholesterol levels . RESULTS Death due to CHD accounted for 26 % , 34 % , and 28 % of all deaths in the CHA , PG , and MRFIT cohorts , respectively ; and CVD death for 34 % , 42 % , and 39 % of deaths in the same cohorts , respectively . Men in all 3 cohorts with unfavorable serum cholesterol levels ( 200 - 239 mg/dL [ 5.17 - 6.18 mmol/L ] and > /=240 mg/dL [ > /=6.21 mmol/L ] ) had strong gradients of relative mortality risk . For men with serum cholesterol levels of 240 mg/dL or greater ( > /=6.21 mmol/L ) vs favorable levels ( < 200 mg/dL [ < 5.17 mmol/L ] ) , CHD mortality risk was 2.15 to 3.63 times greater ; CVD disease mortality risk was 2.10 to 2.87 times greater ; and all-cause mortality was 1.31 to 1.49 times greater . Hypercholesterolemic men had age-adjusted absolute risk of CHD death of 59 per 1000 men in 25 years ( CHA cohort ) , 90 per 1000 men in 34 years ( PG cohort ) , and 15 per 1000 men in 16 years ( MRFIT cohort ) . Absolute excess risk was 43.6 per 1000 men ( CHA ) , 81.4 per 1000 men ( PG ) , and 12.1 per 1000 men ( MRFIT ) . Men with favorable baseline serum cholesterol levels had an estimated greater life expectancy of 3.8 to 8.7 years . CONCLUSIONS These results demonstrate a continuous , grade d relationship of serum cholesterol level to long-term risk of CHD , CVD , and all-cause mortality , substantial absolute risk and absolute excess risk of CHD and CVD death for younger men with elevated serum cholesterol levels , and longer estimated life expectancy for younger men with favorable serum cholesterol levels . JAMA . 2000;284:311 -
There was mixed evidence that provider-level computerized decision support improves outcomes .
There was more evidence in support of patient-level tools that provide connectivity to the healthcare system , as well as system-level interventions that involve data base monitoring and outreach by central ized care teams .
R and omized controlled trials show wide variability in the effects of HIT on lipid management outcomes .
Evidence suggests that multilevel HIT approaches that target not only providers but include patients and systems approaches will be needed to improve lipid treatment , adherence and quality
BACKGROUND Large gaps in lipid treatment and medication adherence persist in high-risk out patients in the United States .
Health information technology ( HIT ) is being applied to close quality gaps in chronic illness care , but its utility for lipid management has not been widely studied .
OBJECTIVE To perform a qualitative review of the impact of HIT interventions on lipid management processes of care ( screening or testing ; drug initiation , titration or adherence ; or referrals ) or clinical outcomes ( percent at low density lipoprotein cholesterol goal ; absolute lipid levels ; absolute risk scores ; or cardiac hospitalizations ) in out patients with coronary heart disease or at increased risk .