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.

Public Health Relevance

Coronary heart disease, stroke, and heart failure remain major causes of mortality and morbidity in the United States. Uncontrolled hypertension is present in 13.7% of all Americans >18 years of age;more than one fifth of adult Americans report never having had their blood cholesterol measured, while a quarter of those with measurements have high cholesterol. This project proposes to improve the control high blood pressure and elevated cholesterol, two of the major reversible risk factors for all three of these serious cardiovascular problems, through innovative electronic audit and feedback to primary care providers of more than 320,000 patients in the Distributed Ambulatory Research in Therapeutics Network.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
NIH Challenge Grants and Partnerships Program (RC1)
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Special Emphasis Panel (ZRG1-VH-D (58))
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Cook, Nakela L
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University of Colorado Denver
Internal Medicine/Medicine
Schools of Medicine
United States
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Hissett, Jennifer; Folks, Brittany; Coombs, Letoynia et al. (2014) Effects of changing guidelines on prescribing aspirin for primary prevention of cardiovascular events. J Am Board Fam Med 27:78-86
Hammermeister, Karl; Bronsert, Michael; Henderson, William G et al. (2013) Risk-adjusted comparison of blood pressure and low-density lipoprotein (LDL) noncontrol in primary care offices. J Am Board Fam Med 26:658-68
Bronsert, Michael R; Henderson, William G; Valuck, Robert et al. (2013) Comparative effectiveness of antihypertensive therapeutic classes and treatment strategies in the initiation of therapy in primary care patients: a Distributed Ambulatory Research in Therapeutics Network (DARTNet) study. J Am Board Fam Med 26:529-38