A Health Coach-Based Multilevel Personalized Strategy Lowers Low-Density Lipoprotein Cholesterol and Enhances Lipid Control in Veterans With Atherosclerotic Cardiovascular Disease.

BACKGROUND: The Veterans Affairs New York Harbor Healthcare System is 1 of 50 Veterans Affairs sites participating in the Veterans Affairs Lipid Optimization Reimagined Quality Improvement Project. Veterans Affairs sites worked with an American Heart Association quality improvement consultant to develop and deploy a plan to achieve low-density lipoprotein cholesterol (LDL-C) <70 mg/dL in >30% of veterans with atherosclerotic cardiovascular disease and uncontrolled LDL-C (LDL-C ≥70 mg/dL), and meaningful LDL-C lowering. METHODS: In this pre-post designed project, health coaches applied a root-cause analysis framework, used medication possession ratio to assess adherence, and used motivational interviewing principles to improve medication adherence and lifestyle habits. Health coaches tailored interventions to address adherence barriers (if medication possession ratio <0.8) or facilitated medication intensification (if medication possession ratio ≥0.8). To evaluate the impact of health coaches on outcomes, we compared baseline and follow-up data pre-post to evaluate LDL-C lowering and assess LDL-C control. RESULTS: Among 152 engaged veterans, 57.9% had LDL-C between 70 and 100 mg/dL at baseline, 41.4% had LDL-C ≥100 mg/dL, and 0.7% had no data in the past year. Median (interquartile range) baseline LDL-C was 92.0 (81.0-118.0) mg/dL, and follow-up was 75.0 (54.5-98.0) mg/dL. Mean LDL-C change from baseline was -22.7 mg/dL (Wilcoxon signed rank test, P<0.001). The proportion with controlled LDL-C was 42.6% (binomial test, P=0.001). All specialties, except geriatrics, lowered LDL-C significantly and exceeded the 30% goal. LDL-C control rates did not statistically differ by specialty (Fisher exact test, P=0.091). CONCLUSIONS: Health coach-delivered interventions to improve medication adherence and encourage lifestyle modifications led to significant LDL-C reduction, with 42.6% achieving control, surpassing the 30% program benchmark, and lowered LDL-C level.