Impact of Performance Improvement Continuing Medical Education on Cardiometabolic Risk Factor Control: The COSEHC Initiative


  • JaNae Joyner PhD,

    Corresponding author
    • Correspondence: JaNae Joyner, 10 CSB Medical Center Blvd., Winston Salem, NC 27157; e-mail:

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  • Michael A. Moore MD, FACP, FAHA, FASH,

  • Debra R. Simmons RN, MS,

  • Brian Forrest MD,

  • Kristina Yu-Isenberg PhD, MPH, RPh,

  • Ron Piccione PhD,

  • Kirt Caton MD,

  • Daniel T. Lackland DrPH,

  • Carlos M. Ferrario MD, FASA, FAHA, FASH, FACC

  • Disclosures: The authors report that financial support for this project was provided by Novartis Pharmaceuticals Corporation (Health Economics & Outcomes Research Division).



The Consortium for Southeastern Hypertension Control (COSEHC) implemented a study to assess benefits of a performance improvement continuing medical education (PI CME) activity focused on cardiometabolic risk factor management in primary care patients.


Using the plan-do-study-act (PDSA) model as the foundation, this PI CME activity aimed at improving practice gaps by integrating evidence-based clinical interventions, physician-patient education, processes of care, performance metrics, and patient outcomes. The PI CME intervention was implemented in a group of South Carolina physician practices, while a comparable physician practice group served as a control. Performance outcomes at 6 months included changes in patients’ cardiometabolic risk factor values and control rates from baseline. We also compared changes in diabetic, African American, the elderly (> 65 years), and female patient subpopulations and in patients with uncontrolled risk factors at baseline.


Only women receiving health care by intervention physicians showed a statistical improvement in their cardiometabolic risk factors as evidenced by a −3.0 mg/dL and a −3.5 mg/dL decrease in mean LDL cholesterol and non-HDL cholesterol, respectively, and a −7.0 mg/dL decrease in LDL cholesterol among females with uncontrolled baseline LDL cholesterol values. No other statistical differences were found.


These data demonstrate that our PI CME activity is a useful strategy in assisting physicians to improve their management of cardiometabolic control rates in female patients with abnormal cholesterol control. Other studies that extend across longer PI CME PDSA periods may be needed to demonstrate statistical improvements in overall cardiometabolic treatment goals in men, women, and various subpopulations.