Justification for Non-substantive Change

Lipid therapy rationale 121113.docx

Uniform Data System

Justification for Non-substantive Change

OMB: 0915-0193

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Recommended Change:

Not implement the lipid control measure approved for UDS data collection in 2014, and continue to have health centers report the lipid therapy measure currently in the UDS.

Rationale:

On October 28, 2013, OMB approval was given for several changes to UDS data collection for 2014. One of these changes was to replace the lipid therapy clinical measure with the lipid control measure endorsed by the Clinical Quality Forum in early 2013. On November 12, 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA), in collaboration with the National Heart, Lung, and Blood Institute (NHLBI) and other specialty societies, released a new guideline concerning cholesterol management in adults. According to the guideline, there is no evidence to support continued use of specific LDL-C and/or non-high-density lipoprotein cholesterol (non-HDL-C) treatment targets.  Rather, the appropriate intensity of statin therapy should be used to reduce risk in those most likely to benefit.

Now that this lipid control target has been called into question, it is appropriate to withdraw the approved 2014 UDS measure and replace it with the current lipid therapy that has been collected since 2012 and is consistent with the new ACC/AHA guideline.  Both the National Quality Forum and CMS currently are re-evaluating the cholesterol management measures in view of the new ACC/AHA guideline.  The additional year of data collection for the lipid therapy measure will establish a three year trend for this measure.  As the NQF and CMS decide the cholesterol management measure to endorse, BPHC will be well positioned to keep its measure aligned with that of these standard setting organizations in the future.  Importantly, reporting clinicians will be assured that the clinical measure for cholesterol management is consistent with national clinical practice standards.  

The attached set of UDS Tables and Electronic Health Records Questionnaire for 2014 includes all approved changes.    

The following links further describe the ACC/AHA Blood Cholesterol guidelines. 

http://content.onlinejacc.org/article.aspx?articleid=1770217.

CardioSource.org provides a brief summary of each of the four prevention guidelines along with 10 points to remember and a patient summary guide: 

http://www.cardiosource.org/news-media/publications/cardiology-magazine/2013/11/new-accaha-prevention-guidelines-address-blood-cholesterol-obesity.aspx?w_nav=RI



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