Cardiovascular Risk Reduction Learning Community (CRRLC)
Reducing risk of major cardiovascular events
Challenge Area and Challenge Topic: This application addresses broad Challenge Area (05), Comparative Effectiveness Research, and specific Challenge Topic 05-HL-104*, Reducing cardiovascular risk in moderate-risk and asymptomatic patients.
Overall Goals: The goals of this project are: 1) Form a Cardiovascular Risk Reduction Learning Community; 2) Electronically collect and analyze data on trajectories of hypertension and LDL-cholesterol control, antihypertensive and hypolipidemic drug prescription and fulfillment data, and relatively mutable and relatively immutable factors associated with hypertension and LDL control; 3) Develop a system for electronic feedback of aggregate data to compare clinic performance and of patient-level data to assist care providers in focusing their efforts in improving blood pressure and LDL control; and 4) Assess incidence and changes in blood pressure and LDL control before and after implementation of feedback to calculate sample size for a randomized controlled trial.
Methods: This project will be conducted in the Distributed Ambulatory Research in Therapeutics Network (DARTNet), a distributed computing network capable of extracting standardized data from electronic health records. DARTNet, composed of 79 practices with about 500 clinicians providing primary care for about 400,000 patients, has demonstrated the ability to conduct observational comparative effectiveness research in a completed pilot project on oral hypoglycemic agents. Working collaboratively with DARTNet care providers, we will analyze three groups of factors associated with hypertension and LDL-cholesterol control to ascertain: 1) The comparative effectiveness of classes of antihypertensive and hypolipidemic drugs in this real-life setting, 2) Other factors within the control of care providers (relatively mutable factors, such as drug doses, patient compliance, etc.), and 3) Relatively immutable factors beyond the control of care providers (e.g., age, gender, race/ethnicity). Feedback of clinic-level performance will adjust for the relatively immutable factors, while care provider feedback will focus on patient-specific data on relatively mutable factors. Then, we will assess changes in hypertension and LDL control before and after implementation of the audit and feedback.
If these results are promising, we will collaboratively plan a large-scale randomized trial to test the hypothesis that the audit and feedback described above will enhance hypertension and LDL-control.
EHR/EMR System or Vendor
Primary care or ambulatory clinics
Electronic Health/Medical Records (EHR or EMR)
Geographic scope type
Locations of Focus
Denver, Colorado; Northern Virginia, New Jersey, Missouri, North Carolina,
Population Network Size
The 33 clinics, which participated in this network, care for approximately 250,000 patients > age 18.
This practice based research network consisted of 10 health care delivery organizations -- each supported by an EHR. Each organization was supported by a proprietary data extraction, transformation, and loading tool purchased and maintained by CINA (http://www.cina-us.com/medicalhome.html); CINA aggregated a pre-specified dataset into a limited dataset for us.
University of Colorado School of Medicine; Colorado Schoo of Public Health' Fairfax Family Medicine; Summit Medical Group; National Research Network, American Academy of Family Physicians, Leawood KS; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora CO
Concordance with JNC7 (blood pressure management) and NECP (lipid management) was measured repetitively at the patient level and aggregated at the clinic level.
Outcome(s) of Interest
Improvement in guideline concordance.
Acknowledgement of Funders
This work was supported by The National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI) Grant 1RC1HL101071-01.hypertension, hyperlipidemia, clinical practice guideline, risk adjustment, guideline adherence