American College of Cardiology

ACC's Quality Strategy

With an increased national focus on the quality of patient care in America, the leaders of the American College of Cardiology Foundation have stepped forward and established a five year plan aimed toward continuous improvement of cardiovascular care. The following report briefly summarizes this plan and the recommendations of the Task Force on Clinical Science and Quality. That Task Force, charged with developing an overall strategy for the Foundation's scientific, clinical, and quality of care activities over 3 to 5 years, considered a broad range of issues and opportunities for the Foundation to more effectively and efficiently improve the quality of cardiovascular care in our country, and delineated six major goals to be implemented through various strategies. Some of these strategies are straightforward and some are complex. And, their accomplishment, no matter how simple or complex, will require an investment of time and resources. But, the profession of medicine must regain control of and responsibility for quality improvement and the College is dedicated to this important mission.

This report was approved by the Board of Trustees March 2002.

Establish quality improvement as a core professional responsibility

• The ACCF should create a demand for quality at the grass roots level.
• The Foundation must educate members about quality and quality improvement, and its relationship to clinical science
• The ACCF should work with the Chapters to develop physician leaders who can champion quality improvement locally.
• The ACCF should work to establish ACC/AHA guidelines as the basis for the clinical policies of those organizations whose policies influence or direct the care of patients with cardiovascular disease.
• The ACCF should provide leadership in efforts to measure, evaluate, and use data to improve the quality of cardiovascular care.
• The ACCF should establish more systematic and effective relationships with the AHA, JCAHO, NCQA, AMA, and the NQF.
• The Foundation must develop a plan for collaboration and partnership, in support of ACCF's leadership and quality goals.

Increase the timeliness, flexibility, and usefulness of ACCF recommendations for clinical care.

• ACCF should undertake a review of the Classification of Recommendations and Level of Evidence systems currently used in the clinical guidelines.
• Policies and procedures to address potential conflicts of interest (COI) must be developed and implemented.
• The ACCF should conduct an evaluation of its peer review process to identify areas for expediting the process while maintaining its rigor.
• Updated Classification of Recommendations and Level of Evidence systems should be applied to other clinical scientific products of the ACCF (e.g., Bethesda Conference Reports, Expert Consensus Documents, etc.) where appropriate.
• ACCF should complete an analysis of the human, technological, and financial resources that will be required to create clinical knowledge that is updated continuously.
• The ACCF should develop a pilot program for a continuously updated "living" guideline (knowledge-base), which maintains the rigorous criteria for translating the results of clinical research and clinical trials into revised recommendations for a given practice guideline.
• The Foundation should evaluate the success of/consolidate the knowledge gained from that pilot program.
• If the pilot is successful, the Foundation should scale up this effort so that it is able to maintain up-to-date clinical knowledge in additional topic areas in cardiovascular medicine.
• The ACCF should evaluate the potential to use its guidelines (clinical knowledge repository) to create customized clinical pathways for hospital use.
• The ACCF should evaluate the possibility of developing an "on-line consult" capability (or the capability to generate guidelines designed for individual patients).

Develop and organize quality improvement tools and the knowledge required to use them

• The ACCF should begin its efforts in this area by evaluating the GAP program, and laying out a plan for its future.
• The ACCF should act as a "clearinghouse" for quality improvement tools and strategies, to facilitate the exchange of strategies, tools, templates, and practice models for local quality improvement programs.
• The ACCF should launch a Quality Improvement demonstration project focused on the 10-12 most critical aspects of (early and late) inpatient care, common to patients with Heart Failure, Acute Coronary Syndrome, and Atrial Fibrillation.
• The ACCF should help patients/consumers understand the basics of quality improvement and quality evaluation, so that they can use available information more effectively and reliably.
• The ACCF should explore the feasibility of developing mechanisms that offer physicians "just-in-time" access, "at the bedside," to clinical knowledge, ideally through systems that permit data capture for documentation.
• The Foundation should develop a tool-kit that supports Chapter and other local efforts to achieve that which is known to be essential to quality improvement.
• The Foundation should develop mechanisms to assure appropriate recognition to physicians, groups, and hospitals that participate in voluntary, ACCF-led, quality improvement efforts.

Create mechanisms to recognize and reward quality.

• The ACCF should stimulate innovation with respect to reimbursement through participation in pilots that assess innovative strategies that link reimbursement to quality in the private sector.
• If these pilots establish feasible and effective mechanisms to improve the quality of care through alternative strategies to reimburse care, the Foundation should extend those pilots to the public sector (that is, promote pilots with CMS and/or with states).
• The Foundation should develop mechanisms to assure appropriate recognition to physicians, groups, and hospitals that participate in voluntary, ACCF-led, quality improvement efforts.
• The National Cardiovascular Data Registry (NCDR) should explore options to create an incentive program that rewards member hospitals for improving performance.
• The Foundation should attempt to influence regulators and accrediting bodies so that participation in Foundation-led quality improvement initiatives will suffice to meet their oversight requirements.

Address the gaps in the information technology infrastructure.

• The ACCF should undertake the activities necessary so that leadership and staff better understand the issues, entities, and opportunities that exist in health care informatics.
• The ACCF should continue its efforts to standardize and promote the standardization of datasets, data definitions, and data collection processes in cardiovascular medicine.
• The ACCF should advocate for and otherwise promote investment in information technology infrastructure.
• The ACCF should pilot a collaborative quality improvement demonstration project in which data are collected once and support feedback, benchmarking, and quality improvement efforts by physicians, hospitals, and the systems in which they provide care.
• NCDR should develop the business and technical relationships necessary to permit data to be shared between NCDR and other CV databases (e.g., STS).

Coordination and centralized planning of quality of care efforts.

• ACC/AHA Guidelines should be produced with clearly defined links to performance measures and clinical data standards.
• The Foundation should establish a steering or oversight committee to assure that the development of guidelines, performance measures, clinical data standards, and GAP/guidelines implementation tools are coordinated.
• The Foundation should establish a mechanism for the coordinated development and implementation of its quality efforts, inter-divisionally.