Abstract 4140295: An Implementation Strategy Package to Improve Familial Hypercholesterolemia Recognition in Primary Care: The CAREFH Study

Background: Familial hypercholesterolemia (FH) is under-diagnosed and under-treated. Goals/Aims/Hypothesis: We developed an implementation strategy package to increase primary care awareness regarding familial hypercholesterolemia. We hypothesized that providers would be more likely to order a screening lipid profile in those without one in the prior 5 years and would be more likely to diagnose FH and/or order genetic testing in eligible patients after intervention compared to the prior 6 months. Methods: The intervention included face to face education regarding FH at 20 primary care locations in the Geisinger Health System, development of electronic health record tools (Smart Set, Dutch Lipid Clinic Score calculator, Clinic Note Template), simplification of genetic test ordering procedures, and notification of primary care providers on the day that patients without a lipid profile in the last 5 years or eligible for an FH workup (presence of premature myocardial infarction or LDL-C > 190 mg/dl) were on their schedule. Data was collected for 6 months prior to intervention and 6-12 months post intervention. Results: In patients without a recent test, lipid profiles were more likely to be ordered in patients post intervention (10,251/40,463 (25.3%) pre vs. 14,574/45,089 (32.3%) post; p < 0.0001). An FH diagnosis was added to the chart more commonly post intervention in patients with phenotypic criteria (6/8129 (0.1%) pre vs 32/7879 (0.4%) post; p < 00001). No patients had genetic testing ordered prior to intervention whereas 37 did afterwards. Electronic health record tools were used at < 1% of encounters. Conclusions: An intervention that includes face to face education regarding FH, simplification of genetic test ordering, and reminders to primary care providers regarding patients eligible for an FH evaluation improves rates of lipid testing, FH diagnosis and genetic test ordering. FH specific electronic health record tools were not frequently used.