2011 ACC: Quality of Care across Different Health Systems

April 4, 2011
Joe Kim, MD

Physicians from several large health systems share their insights and strategies for improving the quality of cardiac care delivered to patients.

Physicians from several large health systems share their insights and strategies for improving the quality of cardiac care delivered to patients.

Today at the American College of Cardiology’s (ACC) 60th Annual Scientific Session and ACC.i2 Summit, I attended a session titled, “Quality of Care across Different Health Systems.” During this presentation, physicians from various health organizations discussed some of the strategies they have been implementing to improve the quality of cardiac care delivered to their patients. Perspectives were shared from the VA Health System, Kaiser Permanente, Midwest Heart Specialists, and the Mayo Clinic. Here’s a very short summary of some of the points that were mentioned:

VA Health System — presented by Dr. Paul A. Heidenreich

The VA health system has been using electronic health records (EHRs) for a number of years. To improve care, the VA is focusing on performance measures and tying compensation directly to those performance measures. The VA is also participating in public reporting in the Medicare Hospital Compare website. Currently, 80-90% of VA hospitals have staff cardiologists. They also rely on the local community of health care providers through their VISN program. Mortality and readmission associated with heart failure is quite variable across different VA hospitals. To improve care, the VA is using its own data to improve quality at each site.

Kaiser Permanente Northern California — presented by Dr. Anthony Steimle

Kaiser currently has more than 9 million members and more than 15,000 physicians. In Northern California, they have 150 cardiologists and 20 hospitals. Like the VA health system, Kaiser uses a robust electronic health record system throughout their network. They have been leveraging health IT to identify care gaps and set appropriate goals. Kaiser works to improve quality of care by developing internal clinical practice guidelines. They also use clinical decision support tools that alert clinicians about evidence-based practice recommendations. Another strategy includes the use of quality metrics and “champions” who share best practice strategies. Kaiser has been an innovator by creating and launching initiatives focused around specific health metrics, such as the cardiac intervention program Prevent Heart Attacks and Strokes Everyday (PHASE). Kaiser has seen a drop in MI by 24% since the implementation of the PHASE program.

Midwest Heart Specialists (MHS) — presented by Dr. Vincent J. Bufalino

MHS is a suburban Chicago private practice with 50 cardiologists. They serve eight different hospitals and they have transitioned from paper health records to electronic health records. They have developed an integrated EHR solution that allows them to access inpatient records and images. They use clinical decision support tools that provide alerts at the point of care. When they transitioned to EHRs, they started by focusing on ensuring that every patient had updated medication lists. Then, they worked with the AMA to embed the AMA Physician Consortium for Performance Improvement (PCPI) measures in 2004. They discovered specific areas that required improvement and found ways to implement improvements. Now, the practice has transitioned into the world of pay for performance and they have been participating in the Medicare PQRI, eRx, and now HITECH meaningful use.

Mayo Clinic — presented by Dr. Henry H. Ting

The Mayo Clinic was one of the medical centers mentioned by President Obama as an “institution that can offer highest level of care at costs well before the national norm.” Mayo has major health sites in three states. They currently employ 3,700 physicians, 220 of whom are cardiologists. Within their organization, a single physician takes the personal responsibility to coordinate care across different specialties. Mayo uses its own “home grown” EHR and focuses on “shared decision making” to facilitate patient and family engagement in treatment decisions. Mayo physicians recognize the importance of involving patients who face medical decisions. What are their personal preferences? What are their social and cultural backgrounds? By focusing on shared decision making, the Mayo Clinic is ensuring that patients are more educated so they can make better medical decisions and adhere to their medications.

Summary

As our nation faces major health care reform, it is interesting to hear perspectives from different health organizations that are seeking to improve the quality of cardiac care. All of these organizations are using health IT data to identify clinical practice gaps and to set performance and quality goals. They are using aggregate data to develop customized initiatives to improve care around specific metrics. There are clearly opportunities for small and large health care organizations to leverage health IT resources to improve the quality of patient care in this era of health care reform.