Transcript Health Care Reform and Cardiovascular Care

The ACC:
Helping CV Professionals
Learn. Advance. Heal.
MEETING
DATE
NAME, CREDENTIALS
TITLE
The American College of Cardiology
We represent…
• 39,000+ members (>90 percent of U.S. cardiologists)
• 7,000 manuscripts submitted
• 20,000 live-event attendees
• 40,000 CME recipients
• 17 million patient records in NCDR®
• 100 million patient visits
The Mission of the ACC
To advocate for quality
cardiovascular care –
through education,
research promotion,
development and
application of standards
and guidelines – and to
influence health care
policy.
What we do
• Quality Care: Leading the way in defining and
implementing quality cardiovascular care
• Education: Providing the best cardiovascular
knowledge for every clinician
• Advocacy: Shaping the future of health care
nationwide to increase access, reduce disparities,
and reward value
What we believe
Science tells us what we can do;
Guidelines what we should do;
Registries what we are actually doing.
Who we are becoming
• Leaders in health system reform
• Resurgent professionals
• Experts in implementation science
• Contributors to global CV health
ACC Quality Approach
An end-to-end system that translates science into practice
PLAN
Improvement
• D2B
• H2H
• FOCUS
Guidelines/Standards
• Guidelines
• AUC / PM
Education
and Training
ACT
Measurement
• NCDR
DO
Implementation - “Bridge”
• Quality Practice Assessment
• Clinical Decision Support
• Operation Management Tools
STUDY
This is our future…
This is now...
That was then...
Launched 1997
1 registry
Focused on quality
patient care
One holistic registry
More than 2,500 hospitals and
1000 practices
International expansion
Health plans and government
regulator adoption
Platform for clinical trials
and CER
Industry uses for market
research, clinical research,
and to support best practice
treatments
More post market
assessment studies
FDA uses NCDR data for post
market assessment
Implement physician
reports to support MOC and
MOL
EHR Integration
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How we’re structured?
Registries
CathPCI
IMPACT
ICD
PINNACLE
CARE
ACTION
GWTG
Registry Studies
NCDR
Translate
ASCERT
Analytics
Guidelines Develop
Educ Needs Assess
Market Intelligence
Quality standards
Data are
used for…
Quality
Improvement
Research &
Publication
Participants, Patient Records, Manuscripts & Abstracts
Name
# of
Participants
# of Patient
Records
# of Manuscripts
& Abstracts
CathPCI
1380
14 million
61/142
ICD
1590
600,000
16/26
ACTION-GWTG
656
225,000
22/41
CARE
170
15,000
3/9
IMPACT
16 pilot sites
2000
1/2
PINNACLE
800
2,100,000
7/21
National CV Data Registry
Imaging
Registry
ICD Long
Number of sites and patient records
IMPACT
Registry
PINNACLE
800, >2.1M
Cath PCI
1380, 14 M
1998….. 2004
ICD
1590, >600K
2005
ACTION
RegistryCARE
GWTG
170, >15K
656, >225K
2006
2007
Afib
Ablation
module
PAD
module
Structural
Heart
Disease
Module
2008
beyond
Multispecialty Representation
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SCAI
HRS
STS
Emergency Physicians
Neurology
Neurosurgery
Pediatrics
AHA
Key Stakeholders
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State Governments
Payors
Medical Societies
Food and Drug Administration (FDA)
Centers for Medicare/Medicaid Services (CMS)
Local Hospitals/practices
Industry
Patients !!
NCDR Research
• Research and Publication Committees
• Research includes
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Post Market Surveillance
Quality Improvement and Translational Research
Inform Public policy
Intense interest in assessing efficiency, return on
investment
– Clinical Outcomes
Non-Evidence-Based Implantable
Cardioverter-Defibrillator (ICD)
Implantations in the United States
• Published in JAMA on Jan. 5, 2011
• Authored by Fred Morady, M.D., F.A.C.C.
• Study concluded that approx. “one-fourth of ICD
implants for primary prevention of SCD in the
United States are not in accord with practice
guidelines.”
• Guidelines are always evolving, but this variation
needs to be
What is H2H?
Goal: Reduce all-cause readmission rates
among patients discharged with HF or AMI by 20
percent by 2012
• National rallying point
• Catalyze action
• Leverage other initiatives
• Rapid learning community
• Building on success
•H2H Challenges: Launched in 2011; community
devised solutions for core concepts
www.H2HQuality.org
H2H Core Concepts
•
Post-discharge medication management.
– Access to the proper medications and proper education on use
•
Early follow-up.
– Follow-up visit scheduled with means of transportation within one
week of discharge
•
Symptom management.
– Recognize the signs and symptoms that require medical attention
and appropriate contact if they appear
Hospital Readmissions and
ACC’s H2H
• Unplanned readmissions cost Medicare
$17.4 billion in 2004, with almost 20% of
all beneficiaries being readmitted to a
hospital within 30 days
• Heart failure is listed as the most common
cause for a patient to be readmitted
• Multi-billion dollar savings possible
Stephen F. Jencks, M.D., M.P.H., Mark V. Williams, M.D.,
and Eric A. Coleman, M.D., M.P.H.
N Engl J Med 2009; 360:1418-1428; April 2, 2009
Quality at the ACC
• Guidelines:
– 19 topics plus 3 new topics in process
• Performance Measures:
– 6 topics plus 2 new topics in process
• AUC:
– 5 topics plus 1 new topic in process
• Data Standards:
– 5 topics plus 1 new topic in process
Existing AUC
• Completed
documents include:
– Echocardiography
(2010)
– Cardiac Computed
Tomography (2010)
– Cardiac Radionuclide
Imaging (2009)
– Coronary
Revascularization (2009)
– Cardiac CT/CMR (2006)
• In Development:
– Peripheral Vascular
Disease
– Diagnostic
Catheterization
– Revascularization
Update
– ICD/CRT
– Multi-Modality
The Revascularization AUC
180 clinical scenarios in acute and
chronic CAD patient presentation
The D2B Quality Alliance:
A Case Study in Success
Registries Can Define QI Targets
27%
Pre-hospital
ECG
Door to reperfusion
times
Risk-adjusted mortality
J Am Coll Cardiol, 2009; 53:161-166
D2B Strategies Reduce MI
Deaths
(December 2009)
• Seventy five percent of participating hospitals in ACC’s
Door-to-Balloon (D2B) Alliance by 2008 were able to
treat ST-segment elevation myocardial infarction patients
within 90 minutes
• This data shows that the way care for heart attack
patients is delivered can make a life or death difference
For more on the study, view the December 15 – 22 issue of JACC.
The study findings were also covered in The Boston Globe (12/2,
Kowalczyk), USA Today (12/3, Sternberg) and HealthDay (12/2, Edelson).
Quality can save money!
Ed Activation of Cath Lab and
Immediate Transfer by Care Team
Door-to-balloon time  from 113 to 75 minutes
Transfer time  from 147 to 85 minutes
Infarct size (creatinine kinase)
Hospital stays  by 2-3 days
Cost  by over 30 percent
U. M. Khot et. Al. Circulation. 2007; 116
The New TAVR/AVR Registry
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ACC and STS Partnership
FDA and Medicare Partnership
All U.S. TAVR Patients
Beginning January 2012
The PINNACLE Registry
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First office-based QI program in U.S.
Data collection system
Assessments and continuous feedback
Clinical decision support tools
Opportunity for recognition as ‘high quality’
EHR interoperable module or web-based
Data extraction by “system integrator”
Is being used in India!
PINNACLE and Data Collection
Insurers
Data collection example:
CAD performance
MEDICARE
PRIVATE
INSURERS
Others
• BP measurement
• Symptom and activity
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assessment
Smoking assessment
Anti-platelet therapy
Lipid profile
Use of lipid therapy
β-blocker post-MI
ACE/ARB in EF4 and
DM4
Screening for diabetes
PINNACLE
Registry®
Ongoing data
submission
to ACC
Practice daily operation
Periodic
data
feedback to
practice
LDL Rx performance keeps climbing, even as new
practices come online
PINN-35 Drug Therapy for Lowering LDL-Cholesterol
100.00%
60
99.00%
97.20%
98.00%
97.50%
50
97.00%
40
95.90%
96.00%
95.40%
95.00%
30
94.00%
20
93.00%
92.00%
10
91.00%
90.00%
0
Q2 2010
Q3 2010
# Practices with sufficient data
Q4 2010
Q1 2011
% Patients prescribed lipid-lowering therapy
A job well done across all practices
PINN-35 Drug Therapy for Lowering LDL-Cholesterol
% Patients prescribed lipid-lowering therapy (based on
current ACC/AHA guidelines)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Q2 2010
Q3 2010
Q4 2010
PINN-35
Year Ending in Quarter Listed
Q1 2011
Encouraging Early Indicators
CardioSource.org:
ACC’s home on the web
CardioSmart
Began as a patient-oriented website…
Broadening into:
 a multi-faceted program
supporting guidelinebased CV care and
prevention
 an extension of the
patient/provider interaction
 a resource to corporate
wellness programs and a
vehicle for health-oriented
messaging
JACC on the iPad
CardioSource Mobile
Cardiology Magazine Online and iPad
The ACC at the
UN Summit on NCDs
“The best way to
predict the future is to
create it.”
-- Peter Drucker
www.CardioSource.org