April 15, 2016

This BOG Update is brought to you by A. Allen Seals, MD, FACC, Chair of the Board of Governors.

Dr. Seals invites each member of the BOG to prepare a short piece for the weekly BOG Update responding to the following question: "What works best in your Chapter for member/patient benefit?" While last year the BOG Update looked at issues facing ACC Chapters, this year will highlight innovations and possible solutions. The submission should ideally be short enough to be read in less than five minutes. This is an excellent opportunity to share successes in your state and learn from other Chapters across the country. Please send your draft to Miriam Surdin (msurdin@acc.org). We look forward to your responses!

Currently, the ACC is in the second year of funding for one of the most innovative ideas born out of chapters to date, SMARTCare. A $15.8 million grant from the Center for Medicare and Medicaid Innovation (CMMI) is supporting the implementation of this landmark project, the largest grant ever undertaken by the ACC. Designed and co-sponsored by the Florida Chapter (FCACC) and the Wisconsin Chapter (WCACC), this innovation grant aims to improve quality of care, enhance access to care and reduce health care costs by providing tools to help physicians and cardiovascular team members apply guidelines and appropriate use criteria (AUC) at the point of care.

SMARTCare is a prime example of how the tools of the college can be combined and applied to large populations of patients to fulfill the ACC strategic plan. In SMARTCare, tools are embedded along the care pathway utilized in the evaluation and treatment of patients with stable ischemic heart disease (SIHD). Tools were selected to enhance patient education and shared decision making, application of AUC at the patient's bedside, catalog patient reported outcomes, while providing patients and physicians ease of access to tracked quality metrics, clinical outcomes, and resource utilization. Tools included in the SMARTCare program:

  • Patient Shared Decision-Making and Reported Outcome: TONIC, SAQ7, Heart Quality of Life, and Decision Quality Assessment Instrument
  • Non-Invasive Clinical Decision Support Tools: FOCUS
  • Invasive Clinical Decision Support: ePRISM, eLUMEN, NCDR Cath/PCI
  • Outpatient Quality Metrics and Clinical Outcomes: NCDR PINNACLE Registry
  • Risk Factor Modification: CardioSmart, INDIGO
  • Patient Education: CardioSmart, HealthDialogs, Dartmouth PCI Decision Grid

While there is often no single answer to patient care decisions, by leveraging SMARTCare clinical tools, decision aids, and educational resources, Cardiologists and their patients are able to take advantage of real-time point-of-care access to data sources based on an individualized patient's history, cardiac risk profile, as well as non-invasive and invasive diagnostic studies.

According to Thomas Lewandowski, MD, FACC, SMARTCare Project Director and Immediate Past Governor of WCACC: "In patients with SIHD, the overarching goals of SMARTCare are to increase the percentage of patients with optimal risk factor modification and to support application of AUC clinical decision support, while achieving high levels of patient engagement, lowering rates of complications, and optimizing quality metrics and clinical outcomes. These are big goals, but we have the right people, the right technology, and the right resolve to make them a reality."

According to Juan Aranda, MD, FACC, Florida SMARTCare Project Director and Immediate Past Governor of FCACC: "Our ability to utilize care patterns from separate state chapters demonstrates how flexible and successful the program can be. We are hopeful that patients from all over the country will be able to take advantage of the tools included in the SMARTCare program."

SMARTCare was developed as a chapter initiative from the Wisconsin and Florida Chapters. The CMMI grant submission named the ACC as the convener and received the unwavering support of senior staff and leadership at the College. The implementation is aided by the expert assistance of e4 Consultants and ACC staff. SMARTCare is performed by the dedication of an extraordinary group of Cardiologists, cardiovascular care team providers and administrators – representing clinical sites in both states.

SMARTCare offers a chance for cardiovascular physicians and cardiovascular team members to align their clinical practice with the best evidence-based recommendations, to improve appropriateness of non-invasive and invasive procedures, to provide a streamlined mechanism for physicians and patients to collaborate in the health care process through shared decision making, and to provide a real clinical-based system to optimize the value of cardiovascular care delivery.

The project described is supported by Grant Number 1C1CMS331322 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. This content is solely the responsibility of the authors and does not necessarily represent the official views of the US Department of Health Human Services or any of its agencies.