Seeking Tools for Best Practices in Cardiac Care

What does the best care look like? How do we give cardiovascular professionals the ability to incorporate the “best care” into their practices or hospitals? This is the question that the American College of Cardiology (ACC) is attempting to answer.

The goal is threefold: 1) to identify gaps or areas of improvement in care; 2) to identify best practices to close these gaps; and 3) to develop practical tools that can be used by the entire cardiac care team to implement best practices. These tools will take on varied formats, from toolkits to pocket guidelines to web-based forms, and they ultimately will be highly automated and available at the point of care.

The ACC recently launched an Atrial Fibrillation (AFib) Toolkit to provide tools and strategies for the patient care team to support high-quality care for patients with AF. In addition to improving physician adherence to performance measures for AF endorsed by the National Quality Forum (NQF), the AFib Toolkit will increase patient awareness of the risks associated with AF and enhance patient engagement in their AF care plan. Provider understanding and inclusion of patient behavior, choices and lifestyles in care planning are especially important with AF because of the rapidly evolving landscape of AF therapies.

AF is responsible for 15 to 20 percent of all strokes, which account for one in 17 deaths in the U.S. and ranks third among all causes of death after heart disease and cancer (National Vital Statistics Report, 2010; Marini et al, 2005). Rather than defining high-quality AF care by clinical performance according to the NQF-endorsed measures, the AFib Toolkit establishes goals for overall AF care by identifying and filling gaps in the knowledge and behavior of the patient and the patient care team in meeting these goals.  
Included in the AFib Toolkit are:

• Five tools focused on diagnosis and risk assessment;
• Four tools, plus 23 individual drug monographs, for treatment and management of AF; and
• Three tools focused on patient education.

The AFib Toolkit will be pilot tested in 10 to 15 outpatient practices that participate in the ACC’s PINNACLE Registry over a three-month period to evaluate its impact on provider performance and patient outcomes. In addition to registry data, the pilot will use survey data collection to evaluate each tool and assess its impact as strategies in meeting the established goals for high-quality AF care. A summary of lessons learned will be provided online at the conclusion of the project for participants and the cardiovascular community.
Also, a Heart Failure (HF) Toolkit, comprised of nine parts, has been developed with the intent of helping cardiovascular professionals:

• Brush up on the guideline recommendations for HF care;
• Understand what to report for HF performance measures;
• Prescribe appropriate drug therapies for HF patients;
• Provide quality education and self-management strategies to patients; and
• Assess their performance improvement before and after using such tools.

In addition, with the release of updated appropriate use criteria (AUC) this year for coronary revascularization, tools will be developed to ensure the most appropriate use of this treatment. Over the course of the next several months, tools will be rolled out to help members adequately assess and document symptoms; involve patients in the decision-making process; and know when to order non-invasive tests and/or prescribe optimal medical therapy before making a decision on diagnostic coronary catheterization.

Whether we are talking about AF, HF or coronary revascularization, cardiologists and other healthcare professionals need real-time, easy-to-use solutions that cross the spectrum of quality, advocacy and education and bring about real change. The efforts under way by a multidisciplinary team of ACC members and staff may bring these tools to life.
Kovacs is chair of the ACC’s Best Practices and Quality Improvement Subcommittee.