Implementing quality assurance programs in multigroup practices for treating hypercholesterolemia in patients with coronary artery disease.

Healthcare reform is driving the development of specialty physician practices into larger regional and national physician networks. These networks arise from the federation of > or =2 practices that negotiate with managed-care organizations for contracts. Developing cardiovascular networks and establishing and implementing lipid management quality assurance programs into the network are presented in this article. Goals of the lipid management program include enhancing the identification, diagnosis, education, and comprehensive treatment of patients with cardiovascular disease. Utilizing an integrated, coordinated, multidisciplinary approach to lipid management allows the cardiology network to improve patients' quality of life, reduce long-term costs, and gain a competitive advantage for successful contracting. A network lipid management program involves targeting eligible patients and treating them to a targeted level for low-density lipoprotein (LDL) cholesterol where possible. Among cardiologists, there is a consensus that achieving an LDL cholesterol of < 100 mg/dL for patients with pre-existing cardiovascular disease is desirable. Secondary lipid management program goals include: (1) collecting, storing, and analyzing patient demographics; (2) implementing programs involving lifestyle modification, smoking cessation, weight control; and (3) measuring clinical and economic outcomes. Convergence of several driving forces in managing hypercholesterolemia provides cardiologists with the ability to improve the process. These forces include: market-consolidated delivery systems, established lipid management guidelines, and employer-initiated policies requiring higher quality care within managed-care organizations. Methods to achieve enhanced treatment effectiveness, patient satisfaction, and control costs are discussed. Utilizing multidisciplinary teams including nurse case managers, clinical pharmacists, dietitians, and physician assistants to achieve lipid level goals and for nutritional counseling is desirable. Developing disease state management programs, treatment algorithms, databases with analytic reports, and process improvement across the network is of paramount importance for future progress and success.