515 - The Collaborative Approach to Reach Everyone with Familial Hypercholesterolemia

Publication Number: 4505.515

Matthew C. Nelson, Geisinger, Danville, PA, United States; Dylan Cawley, Geis, SCRANTON, PA, United States; Yirui Hu, Geisinger, Danville, PA, United States; Laney K. Jones, Amgen, White haven, PA, United States; Samuel S. Gidding, Samuel S Gidding, Danville, PA, United States

Background: Familial Hypercholesterolemia (FH) is a common genetic disorder (prevalence 1 in 250) that leads to premature cardiovascular disease. Early detection and treatment of FH prevents at least 75% of associated heart attacks and saves lives. Universal lipid screening in children has been recommended to help close this gap, but uptake has been poor.

Objective: The Collaborative Approach to Reach Everyone with Familial Hypercholesterolemia (CARE-FH) study aims to evaluate the effectiveness of a multi-level implementation strategy package in improving pediatric lipid screening and FH evaluation rates at Geisinger, an integrated health care system.

Design/Methods: A stepped wedge hybrid effectiveness-implementation trial was implemented across 5 phases from 2022-2024. Lipid orders and completion rates were collected during this time across 22 primary care pediatric clinics. Interventions included EHR prompts, clinician education, outreach, and audit-feedback loops. Outcomes were measured using cross-sectional comparisons of pre and post intervention lipid screening rates.

Results: After intervention, lipid order rate increased by 70-100% across clinics, from about 11% at baseline, with sustainment or further improvement noted over a 2-year period, to final rates of 30-40% (see Table, P < 0.001). A secular trend towards increased screening also occurred across the system (Table, bottom row). Completion of the lab draw was a barrier to screening; 15,189/25,713 (59%) lipid orders were resulted. Nearly 1% (102/15,189 or 0.7%) of pediatric lipid profiles were ≥ 160mg/dl indicating possible FH.

Conclusion(s): A multi-level implementation package strategy improved pediatric lipid screening rates at a single integrated health care system. Early identification of FH in primary care is feasible and scalable. The sustained improvements suggest the potential for broader adoption across other health systems.

Pediatric Lipid Screening Order Rates Before and After Intervention at Six-Month Intervals
Pediatric lipid screening order and completion rates were assessed at six-month intervals across five intervention cycles. Each cycle introduced the intervention to a new cohort of clinics and was compared to non-intervention clinics and prior performance. Completion rates significantly increased after intervention in each cycle. There was a secular trend towards increased screening rates in both pre- and Post- intervention groups.