P2B281: Standardizing Lipid Management (SLiM): Utilizing Quality Improvement Tools to Improve Management of Dyslipidemia in the Primary Care Setting

Purpose/Objectives: Dyslipidemia is found in 7.8% of children aged 7-18 years and is associated with increased risk for future cardiovascular events. Despite the American Academy of Pediatrics (AAP) recommendations for universal lipid screening and management of dyslipidemia, there is sizeable practice variation among pediatricians. As a large primary care network of 14 clinics, >100 providers, and >227,000 patient encounters annually, we encounter considerable variability in management after lipid screening. This practice variability could lead to suboptimal future cardiovascular outcomes for patients. Our objective was to improve appropriate management of abnormal lipid values in our pediatric primary care network.

Design/Methods: Our interventions focused on improving provider understanding of the diagnosis of dyslipidemia and enhancing provider and family education regarding dyslipidemia management. Educational presentations on dyslipidemia were given to primary care providers at division-wide meetings. A flowchart was created to aid provider decision-making regarding lipid test results (Figure 1). Easily accessible scripts were created in the electronic medical record (EMR) to help providers communicate management recommendations to patient families. Ultimately, recommended responses to abnormal lipid values were integrated into the EMR results section.

The outcome measured was the percentage of results with appropriate management after abnormal lipid screens. Appropriate management depended on degree of dyslipidemia and could include: repeating the lab in 1 year, diet/lifestyle interventions with repeat lab sooner, or urgent referral to a specialist. We tracked both the placement of repeat lab orders for future draw and referrals as indicators of appropriate management.

Results: At baseline (January-September 2020), 25% of abnormal results were being managed correctly (Figure 2). After the first division meeting presentation and distribution of the flowchart, the percentage increased to 40% (Sept 2020-December 2021). After recommended interventions were integrated into the results section of the EMR along with a second division meeting presentation, the percentage increased again to 54% (January 2022-February 2023). This improvement has been sustained for 1 year.

Conclusion/Discussion: We were able to increase the appropriate management of abnormal lipid values from a baseline of 25% to 54% using several QI interventions, and these results have been sustained over time. It was helpful to provide education along with clear guidelines in easily accessible formats to aid in real-time decision making. Utilizing the EMR to provide guidance on result management made a significant impact on provider response to abnormal lipid values. Our next steps are to improve diet and lifestyle recommendation guides for providers and families, and to further integrate practice tools into our EMR.