| Name | Value |
|---|---|
| NAME | VA-IHD ELEVATED LDL |
| PRINT NAME | IHD Elevated LDL |
| CLASS | NATIONAL |
| SPONSOR | OFFICE OF QUALITY & PERFORMANCE |
| USAGE | * |
| EDIT HISTORY |
|
| DESCRIPTION | The VHA/DOD Clinical Practice Guideline for Management of Dyslipidemia If a more recent record of an UNCONFIRMED IHD DIAGNOSIS is found, the reminder will not be applicable to the patient. Documenting an outside LDL <120 mg/dl satisfies the reminder for 12 months from the lab test date. Ordering initial lipid lowering medications or adjusting current lipid lowering medications satisfies the reminder for 2 months. (This is tracked by Health Factors, not the order.) recommends an LDL goal of <120 mg/dl for patients with Ischemic Heart A patient's refusal of lipid lowering therapy satisfies the reminder for 6 months. Documenting that no treatment change is needed based on patient's current clinical status, that lipid management is provided by another VA or non-VA facility, or deferring lipid treatment for other reasons satisfies the reminder for 6 months. Documenting that lipid lowering medications are contraindicated satisfies the reminder for 12 months. Disease; and the NCEP Adult Treatment Panel II recommends a more stringent goal of <100 mg/dl. This national reminder identifies patients with known IHD (i.e., a documented ICD-9 code for IHD on or after 10/01/99) who have had a serum lipid panel within the last year, where the most recent LDL lab test (or documented outside LDL) is greater than or equal to 120 mg/dl. |
| FINDINGS |
|
| FUNCTION FINDINGS |
|
| TECHNICAL DESCRIPTION | This reminder is recommended for use by clinicians at Primary Care Clinics
IHD DIAGNOSIS
2. Use the Reminder Dialog edit option to define the national
reminder dialog finding items which should be updated during CPRS
GUI reminder processing.
Review dialog elements in the national reminder dialog and change
any national health factors to local health factors, if
necessary. It is not unusual for local findings to be used in
your national dialogs.
No mapping necessary. Use the VA-ISCHEMIC HEART DISEASE
Any local findings used in the national dialogs should be mapped
to the appropriate national reminder term.
Add local Order Dialog items to the Dialog elements used for
ordering a calculated LDL and/or direct LDL, and AST/ALT.
Add local Order Dialog items to the Dialog Elements for clinicians
to order initial lipid lowering medications or lab work. The
dialog group contains a sampling of orders related to starting the
patient on lipid lowering medication, which includes future lab
reminder taxonomy distributed with this term.
orders to monitor liver function and lipid levels. The distributed
group contains:
Order Simvastatin -- Note: Sites using a different first line
lipid lowering agent should replace Simvastatin with that
medication (e.g., Pravastatin), which will require
copying the national dialog reminder, and editing the
local copy with local dialog elements.
Order baseline LFTs today (if not available w/in past year).
Order LFTs in 60 days after starting therapy.
Order fasting Lipid Profile in 60 days.
The Adjust lipid lowering medication dialog group contains a
dialog element that recommends using the meds and order tab to
cancel old and order new medications. It also includes dialog
elements for future lab orders to monitor liver function and
lipid levels.
Order LFTs today (if not available w/in past year).
UNCONFIRMED IHD DIAGNOSIS
Order LFTs in 60 days after starting therapy.
Order fasting Lipid Profile in 60 days.
3. Alternatively, use the Reminder Dialog options to copy the national
dialog, dialog elements, and dialog groups to make local changes.
If your site has a Lipid Panel and AST/ALT TIU Object, add this
TIU Object to the dialog element header text. The TIU Object
should include Chol, Trigly, HDL, LDL-C, direct LDL, AST, and ALT
values and dates.
Use the UNCONFIRMED IHD DIAGNOSIS health factor
Some sites have clinicians order a consult to a service that
corrects unconfirmed diagnoses the clinician finds in a patient's
record. If your site has this method in place, copy the reminder
dialog to a local reminder dialog and then add a local dialog element
for the consult order to the reminder dialog so this practice can
continue.
distributed with this term or add any local health
factor representing an unconfirmed or incorrect IHD
diagnosis.
(Primary Care/Medicine, GIMC, Geriatric, Women's), Cardiology, Cholesterol
LDL >119
Enter the Laboratory Test names from the Lab Package
for calculated LDL and direct LDL with a CONDITION to
identify LDL values > 119. Although the condition is
defined in the reminder, also define the condition in
the term so the term can be used for uses that don't
involve the reminder definition. If your site uses
comments frequently you may want to change the condition
to check for specific text.
Screening and any other specialty clinics where primary care is given.
LDL <120
Enter the Laboratory Test names from the Lab Package
for calculated LDL and direct LDL with a CONDITION to
identify LDL values < 120. Although the condition is
defined in the reminder, also define the condition in
the term so the term can be used for uses that don't
involve the reminder definition. If your site uses
comments frequently you may want to change the condition
to check for specific text.
For the following OUTSIDE LDL Reminder Terms, use the
health factors distributed with these terms or add any local
health factors or other findings to the appropriate reminder
terms. The findings should represent LDL values from a source
outside the local facility.
OUTSIDE LDL <100
Distributed with health factor: OUTSIDE LDL <100
OUTSIDE LDL 100-119
Distributed with health factor: OUTSIDE LDL 100-119
Setup issues before using this reminder:
OUTSIDE LDL 120-129
Distributed with health factor: OUTSIDE LDL 120-129
OUTSIDE LDL >129
Distributed with health factor: OUTSIDE LDL >129
LIPID LOWERING THERAPY MGMT - 2M
Use the health factors distributed with this reminder term
or enter any local health factors or other findings that
should defer the reminder for 2 months. Health Factors
distributed with this reminder term are:
LIPID LOWERING MEDS INITIAL ORDER
LIPID LOWERING MEDS ADJUSTED
LIPID LOWERING THERAPY MGMT - 6M
Use the health factors distributed with this reminder term
or enter any local health factors or other findings that
should defer the reminder for 6 months. Health Factors
distributed with this reminder term are:
NO CHANGE IN IHD LIPID TREATMENT
OTHER DEFER ELEVATED LDL THERAPY
1. Use the Reminder Term options to map local representations of
LIPID MGMT PROVIDED OUTSIDE
REFUSED ELEVATED LDL THERAPY
Use the REFUSED ELEVATED LDL THERAPY health factor
distributed with this term or add any local health
factor representing the patient's refusal to have
elevated LDL therapy provided.
LIPID MEDS CONTRAINDICATED
Use the LIPID MEDS CONTRAINDICATED health factor
findings:
distributed with this term or add any local health
factors representing contraindication to lipid lowering
medications.
LIPID LOWERING MEDS
Enter the formulary drug names for investigation drugs.
Mapping non-investigative formulary drugs to the
VA-GENERIC drugs in the Pharmacy Package will ensure
the lipid lowering agents are found. The medications
are informational findings for this reminder.
TRANFERASE (AST) (SGOT)
This reminder term should already be mapped at your site
from the Hepatitis C EPI patch setup. The AST lab test
is an informational finding in this reminder.
ALANINE AMINO (ALT) (SGPT)
This reminder term should already be mapped at your site
from the Hepatitis C EPI patch setup. The ALT lab test
is an informational finding in this reminder.
|
| CUSTOMIZED COHORT LOGIC | FI(1)&FF(1)&(FI(5)!FI(6)!FI(7))&FF(2) |
| INTERNAL PATIENT COHORT LOGIC | FI(1)&FF(1)&(FI(5)!FI(6)!FI(7))&FF(2) |
| PATIENT COHORT FINDINGS COUNT | 6 |
| PATIENT COHORT FINDINGS LIST | 1;FF1;5;6;7;FF2 |
| INTERNAL RESOLUTION LOGIC | (0)!FI(9)!FI(10)!FI(11)!FI(12) |
| RESOLUTION FINDINGS COUNT | 4 |
| RESOLUTION FINDINGS LIST | 9;10;11;12 |
| INFORMATION FINDINGS COUNT | 7 |
| INFORMATION FINDINGS LIST | 3;4;8;13;14;15;16 |
| WEB SITES |
|
| # OF GEN. COHORT FOUND LINES | 0 |
| # GEN. COHORT NOT FOUND LINES | 0 |
| # GEN. RES. FOUND LINES | 0 |
| # GEN. RES. NOT FOUND LINES | 0 |
| BASELINE AGE FINDINGS |
|
| # SUM. COHORT FOUND LINES | 0 |
| # SUM. COHORT NOT FOUND LINES | 0 |
| # SUM. RES. FOUND LINES | 0 |
| # SUM. RES. NOT FOUND LINES | 0 |