This post is authored by Richard J. Kovacs, MD, FACC, chair of the ACC’s Clinical Quality Committee.

As a result of continued hospital and practice integration, as well as an ongoing evolution to a health care system focused on value, not volume, a trend towards more highly centralized and organized systems of care is emerging as a means of meeting the triple aim of improved outcomes, better care and lower costs.

As a concept, centralized care allows for common standards and goals across a system, making identifying problems or gaps in care, monitoring progress and achieving results more streamlined and arguably easier. However, moving from concept to reality does have its challenges given the need for alignment among a diverse group of stakeholders across the care continuum, as well as the need to overcome clinical, administrative and macroeconomic factors that differ from system to system.

Obviously cardiovascular care is not immune from this growing trend. Recent studies and even new clinical guidelines stress the importance of working across the cardiovascular care team, as well as with other specialties, to treat cardiovascular patients with diabetes, hypertension, atrial fibrillation (AFib) and valve disease to name just a few. How to do this most effectively continues to be the big question – and one that the ACC is committed to helping answer.

For example, this past December the ACC convened a number of stakeholders for a one day summit on how best to manage anticoagulation care for patients with non-valvular AFib in an organized system of care environment. Despite advances in therapy and the dedicated efforts of clinician groups like the ACC’s Anticoagulation Initiative, appropriate anticoagulation treatment of these patients remains suboptimal. The reasons for this are varied, but include a lack of interoperability between EHR systems, the number of clinicians across systems and/or specialties involved in a single patient’s care, varied levels of knowledge about treatment options among clinicians and patients, and the complexity of proper therapy and dosing choices.

The Summit explored the diverse sets of variables driving therapeutic decision-making within organized systems of care, as well as opportunities for addressing knowledge and process gaps in the future.  While a more detailed report on the summit is expected later this year, participants did cite lack of infrastructure and inadequate cost and reimbursement structures as two key barriers to an effective centralized system. They also identified the importance of addressing patient education needs, as well as the clinical knowledge needs of clinicians, in order to be truly successful.

As the professional home of the entire cardiovascular care team, the College prides itself in being able to bring together diverse stakeholders to help improve the quality of care being provided to patients living with heart disease. Summits like the one this past December offer unique opportunities to develop recommendations that can ultimately lead to clear solutions and resources that can be used broadly in health care systems.

Learn more about the ACC’s quality improvement efforts.

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