Introduction: Hospital Based Wellness Center developed an intense disease management strategy (CMP) to reduce LDL cholesterol (LDL-C) to the recommended levels according to Evidence-Based Guidelines (EBGs). A review of the literature shows that a primary-care-only practice results in approximately 30% of patients achieving the EBGs. However, a physician-led case-managed approach may achieve the EBG 50%-60% of the time. An intense wellness-center-based CMP working with referring physicians may provide outstanding clinical results in reduction of LDL-C.

Methods: Low-, moderate-, and high-risk LDL-C goals were based on the EBGs as published by the American Heart Association and the National Cholesterol Education Program Adult Treatment Panel-III. We analyzed 3 groups of clients completing at least 4 months (range = 4-13 months) of our CMP all of which had abnormal LDL-C according to their risk stratification. Group 1: No statin at entry (IE) or at follow-up (FW) (NN; n = 119); no statin at entry but on statin at follow-up (NY; n = 8); and on a statin at entry and remained on a statin at follow-up (YY; n = 78). Case managers (CM) maintained close communication with the referring physician as to the treatment plan and recommendations. This physician-led and staff-facilitated approach followed the treatment protocols set forth in the NCEP ATP-III document.

Results: The NY group (N = 8) had a 63% achieve goal (AG) rate. This subgroup also had a reduction in Framingham Risk (FRAM) of 52%, and five achieved <10% FRAM. The YY group made AG of 31% at goal at FW, and a FRAM of 71% AG. The NN group made AG <1% (1) at FW, and FRAM AG of 6%.

Discussion: The NY and YY groups had excellent improvement in their LDL-C and other lipid measures. The FRAM for these 2 groups AG 70% rate (60/86). However, those clients in the NN group continued to struggle to AG. Interestingly, there were differences between the NN and NY/YY groups that included case manager visit frequency above the minimum required, CM experience, CM clinical experience, and physician interaction. These are not scientifically based, but when querying data based on CM and physicians, these trends indicate areas that may contribute to success or failure in disease management programs.