Evaluation of angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers in patients with coronary artery disease and diabetes mellitus or left ventricular systolic dysfunction within an accountable care organization

Introduction: This quality improvement study will target high risk patients within Triad HealthCare Network’s Medicare Shared Savings population. The network primary care physicians have quality metrics that they must meet each year. One of the quality measures is the use of ACE inhibitor or ARB therapy for patients with coronary artery disease and diabetes and/or left ventricular systolic dysfunction.

Objectives: The primary objective is to evaluate the impact of pharmacist education intervention on the use of ACE inhibitors and ARBs in patients with coronary artery disease and diabetes and/or left ventricular systolic dysfunction within an accountable care organization (ACO) and to evaluate the impact of the ACO’s fulfillment of the quality metric. Secondary objectives include evaluating documentation within electronic medical record for contraindications to ACE inhibitor or ARB therapy and evaluating the number of pharmacist recommendations that are approved by providers.

Study Design: A prospective, educational, quality improvement study of THN patients with coronary artery disease and diabetes and/or left ventricular systolic dysfunction not on an ACEI inhibitor or ARB.

Methods: High Risk Patients have already been identified within the ACO who have not met this medication related quality metric and they will be targeted. Recommendations will be communicated to the THN provider and will include missing, harmful, or suboptimal therapy. The response to these recommendations will be monitored. The THN practices with the lowest quality metric score will be targeted for education by a pharmacist.

Results: Out of 112 high-risk patients identified by a previous targeted medication review, 51 (46%) patients have an indication for ACE inhibitors or ARB therapy but are not on it. Many health care providers have cited chronic kidney disease (CKD) as the contraindication to ACE inhibitors or ARB therapy. Further data analyses in progress.

Conclusions: study projected to be completed by March 31st, 2016.