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Israel Journal of Health Policy Research

, 4:20

First Online: 01 June 2015Received: 15 September 2014Accepted: 26 March 2015DOI: 10.1186-s13584-015-0016-9

Cite this article as: Vinker, S., Bitterman, H., Comaneshter, D. et al. Isr J Health Policy Res 2015 4: 20. doi:10.1186-s13584-015-0016-9


BackgroundIn 01-2011 Clalit Health Services CHS, changed the LDL-Cholesterol target definitions in its quality indicators program, from a universal target to values stratified by risk assessment based on ATP III criteria. The objective of this study is to evaluate the effect of this change on achievement of LDL-C targets and on physicians’ prescriptions of statins.

Study Design: A descriptive study based on administrative dataset 06-2010-06-2012.

MethodsSetting: CHS, The largest health maintenance organization in Israel that insures above 4,000,000 beneficiaries.

Patients: Patients who had been in the same risk group throughout the study period.

Measurements: Attainment of targets for LDL-C and purchases of statins prior to, and following, implementation of the guidelines in the CHS quality indicators program.

Results433,662 patients remained in the same risk groups throughout the study period; 55.8% were women; the average age was 53.0 ± 10.3 years; 63.9%, 13.4%, and 22.7% were at low, medium, and high risk respectively. After implementation, the proportion of patients reaching LDL-C targets increased in all risk groups: from 58.6% to 61.6%, from 55.1% to 61.1%, and from 44.5% to 49.0%, in low, medium, and high risk groups respectively p < 0.001. The proportion of patients treated with potent statins increased in all risk groups; from 3.4% to 5.6%, from 6.7% to 10.3%, and from 14.5% to 20.3% respectively p < 0.001.

ConclusionThe risk stratification approach as a basis for the quality indicators program was implemented and better achievement of target LDL-C levels ensued. We suggest that implementation of quality indicators that are consistent with the current literature can lead to improvements that exceeds temporal trends.

KeywordsQuality indicators Clinical guidelines Hypercholesterolemia Statins AbbreviationsATP IIIAdult Treatment Panel III

CHSClalit Health Services

HDLHigh density lipoproteins

LDL-CLow density lipoprotein cholesterol

PCPPrimary care physician

NNTNumbers needed to treat

NHANESNational Health and Nutritional Examination Survey

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Autor: Shlomo Vinker - Haim Bitterman - Doron Comaneshter - Arnon D Cohen


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