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Science to Practice: The ACC Tapestry

Science to Practice: The ACC Tapestry. The Quality Colloquium August 21, 2006. Janet S Wright MD FACC. American College of Cardiology Mission.

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Science to Practice: The ACC Tapestry

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  1. Science to Practice: The ACC Tapestry The Quality Colloquium August 21, 2006 Janet S Wright MD FACC

  2. American College of Cardiology Mission To advocate for quality cardiovascular care — through education, research promotion, development and application of standards and guidelines — and to influence health care policy.

  3. ACC Goals • Recognized leaderin cardiovascular science, knowledge, & best practices • Accelerate applicationof science, knowledge, & measurement into practice • Build partnershipsto improve the delivery of high quality CV care

  4. The Venn of ACC Science

  5. Start with the Science • Practice Guidelines (1984) • Expert Consensus Documents • Competence & Training Statements • Clinical Data Standards • Clinical Performance Measures • Appropriateness Criteria

  6. Accelerate Application • Guideline tools • Self Assessment Programs • Focus on outcomes: • ACC-NCDR® • GAP • Medical Directors’ Institute • Appropriateness Criteria

  7. ACC-NCDR National CV Data Registry • Diagnostic Caths/Coronary Interventions • > 700 labs and > 2.5 million pt records • Implantable Cardioverter Defibrillators • Official CMS database • Carotid Interventions • Meets CMS requirements for data collection

  8. Science and Quality Meet • Guidelines Applied in Practice or GAP • AMI in Michigan: 1=> 5=> 33 hospitals • Heart Failure in Oregon • Stable Angina in Alabama • National Door to Balloon (D2B) Initiative Highlight team-care, care coordination, power of data to improve outcomes

  9. MDI Genesis, circa 2001 • Healthcare is a mess

  10. MDI Genesis, circa 2001 • Healthcare is a mess • Solutions will require teamwork

  11. MDI Genesis, circa 2001 • Healthcare is a mess • Solutions will require teamwork • Health plans & cardiologists at odds

  12. MDI Genesis, circa 2001 • Healthcare is a mess • Solutions will require teamwork • Health plans & cardiologists at odds • “Let’s put on a show!”

  13. The Medical Directors’ Institute is a national, action-oriented community committed to solving mutual problems on a local level.

  14. MDI Objectives • Build relationships among CV specialists, payers, and purchasers • Identify opportunities for collaborative solutions • Execute plans of action on national & local levels to improve healthcare

  15. MDI-The Early Years • 2002-identified mutual problems • 2003 • Utilization of Imaging • Disease Management • Measuring & Paying for Quality

  16. MDI 2004 • Information Technology and EMRs • Who pays? Who benefits? What works? • Employer/Purchaser input is KEY • Crisis in Imaging Use and Cost • Advise us now or live with our remedies! • Go Nuclear

  17. MDI 2005 • Principles for Pay for Performance • Ambulatory Performance Measures • Collaborative effort with PCPI • NQF endorsed • Staged implementation • Appropriateness Criteria (AC) for Nuclear Imaging

  18. MDI Pilots in Progress • Clinical vs Administrative Data • Physician Recognition Program • Ambulatory Discharge Contract in EMR • Medicare Health Support Programs • Aetna in Chicago metropolitan area • American Healthways in Maryland/DC • Health Dialog in Pennsylvania

  19. MDI 2005 Directives • CMS is key partner • Formalize MDI Governance • Provide input into design of CV COEs • Participate in AQA work • Ambulatory Registry for CV Disease • Appropriateness Criteria for Computed Tomography/MR, Echo

  20. What are Appropriateness Criteria? Evidence-based, clinical judgment-informed guidance to help physicians select • Right test or procedure • Right Patient • Right Time

  21. Explosive growth of CV imaging Substantial regional variation True nature of utilization unknown New technology on the horizon Clinicians, patients, payers, purchasers all seeking guidance Why Appropriateness Now?

  22. MDI 2006Systematic Appropriateness • Coordinate care with primary physicians • Design a utilization policy to drive AC • Identify the tools and systems to capture, measure, and report adherence • Establish the benefits of AC adherence • Educate consumers about AC-driven care

  23. Implementing Appropriateness Criteria ACC How can practices use AC to improve care? What resources do practices need to apply AC? How can HPs use AC? What impact can AC have on cost and quality? Payers 2010 2006 All patients receive EBM Physicians deliver EBM efficiently Payers buy quality Here are the data! 45% of patients are receiving EBM Physicians want to provide EBM Payers want to buy quality Show me the data!

  24. Key Lessons Learned • Science => practice takes > a village • Focus on quality • OVER-communicate • Build on successes/learn from failures • Data + incentive => change

  25. More • www.acc.org • www.cardiosource.org • janetwright@sbcglobal.net

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