This post comes from ACC immediate past President James Dove, M.D., M.A.C.C. Dr. Dove is a clinical professor of medicine, Division of Cardiology, at Southern Illinois University, and a founding partner of Prairie Cardiovascular Consultants, Ltd., a 42-member group of cardiologists. As president, Dr. Dove set in motion ACC's efforts in implement quality in cardiovascular care.

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For 25 years, the American College of Cardiology Foundation and the American Heart Association have produced clinical practice guidelines.  These guidelines carefully review the available evidence, rank the importance and significance of major trials and the voluminous medical literature. The results are lengthy guidelines with a series of recommendations, classified as I, IIa, IIb, and III, depending on the strength of the recommendations.

The documents are a wonderful distillation of the literature and serve as a tremendous resource guide to practitioners.  They are, however, difficult to apply at the bedside.  Numerous attempts have been made by the College to help address that difficulty.  Wall charts, pocket guides and other tools have been produced in an effort to facilitate clinical application.  These processes, while helpful, have failed in the application of the Class I guideline recommendations 100% of the time in every patient in whom the recommendations are appropriate.

Best practices in the future will use computer decision-support tools (CDS) that function well within the clinical workflow and facilitate decision-making as well as providing reminders at the point of care.  These tools can also automatically collect process measures without requiring additional time-consuming chart reviews.  Computer decision-support tools will allow us to apply the guidelines every time to every patient for whom the guideline is appropriate and to document clearly the reasons a specific recommendation is not appropriate for a given patient.

The time is now to adopt and develop these computer decision-support tools to function at the point of care, document quality and facilitate our adherence to best medical practices. 

This is not cookbook medicine – instead, it allows us for the first time to effectively collect data about adherence to guidelines, appropriate deviations from guidelines, and eventual correlation of process measures and the effects of those measures on clinical outcomes.   There is no better way to document the significance of process measures of all classification levels than to do so at the point of care and correlate that information with clinical outcome in thousands of patients.

- By James Dove, M.D., M.A.C.C., ACC immediate past president

* Dr. Dove's post is the fourth in a new monthly series of guest posts by ACC leadership. Check back next month to see which ACC leader is sharing his or her thoughts on health care reform!

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