Alliance seeks to improve cardiac care in hospitals

ACE sets aggressive goals to improve patient care

Twenty-nine leading health care organizations have joined forces to form an organization called the Alliance for Cardiac Care Excellence (ACE), whose goal is to ensure that all cardiac patients in the United States receive care consistent with nationally accepted standards.

The new coalition includes leaders from the American Hospital Association, the Centers for Medicare & Medicaid Services (CMS), the Agency for Healthcare Research and Quality, the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America. ACE members hope to help bridge the gap between clinical procedures and treatments proven to be most effective and the care many adult cardiac patients actually receive.

The coalition will begin its focus on care measured by seven basic quality measures. Today, according to ACE, only about 85% of eligible adult cardiac patients treated in U.S. acute care hospitals receive such care. To ensure that all hospitals are consistently delivering quality patient care aligned with recommended standards and guidelines for heart attack and heart failure, ACE has established the following target goals:

  • By Dec. 31, 2006, 95% of eligible adult patients hospitalized for heart attack and heart failure in U.S. acute care hospitals will receive care that meets all of the seven basic quality measures currently reported on the Hospital Compare web site.
  • By Dec. 31, 2007, 95% of eligible adult patients hospitalized for heart attack and heart failure in U.S. acute care hospitals will receive appropriate care on the full set of the 12 quality measures that apply to the patient.

"ACE is committed to improving the quality of cardiovascular care in a number of areas, but at the moment we are focusing on the hospital environment," notes Rose Marie Robertson, MD, Chief Science Officer of the Dallas, TX-based American Heart Association.

One of the reasons ACE came together, she says, was to focus the efforts of a number of groups that are already working on quality improvement and agree upon their next set of goals. "If we all get together, we hope we can speak with a louder voice and help more people," she says.

Many ACE partner organizations — including the American Heart Association, the Institute for Healthcare Improvement, the American College of Cardiology, CMS's Quality Improvement Organizations, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Premier and VHA, Inc. — already are conducting hands-on programs with hospitals to help them achieve the ACE goals.

For example, the American Heart Association's "Get with the Guidelines" program is in more than 1,000 hospitals.

"A lot is being done, and the hospitals have really been enthusiastic, but that's not all the hospitals," says Robertson. "We want to make it clear which programs you can call to help with a new QI program."

Hospitals, she notes, need to report on many of these measures, and these programs can be of tremendous help. "Some of them — including ours, provide web-based tools — reminders of all quality indicators for physicians. And, you can look up how your hospital is doing and get reports back."

To ensure that every adult hospitalized for treatment of heart attack or heart failure receives appropriate, quality cardiac care, ACE member organizations will work to:

  • develop and communicate common messages about the appropriate care for adult heart attack and heart failure patients to health care providers and hospitals;
  • support public reporting of compliance with nationally accepted standards of care, and those agreed upon by ACE;
  • identify hospitals not successfully engaged in quality improvement programs and inform them of those programs that may work best in their unique facilities;
  • remain knowledgeable about — and align tools or programs in accordance with — the most current developments in cardiovascular science;
  • monitor and publicly report progress toward established goals and develop new goals that improve cardiovascular patient outcomes;
  • remove barriers, such as regulatory, payment or other policies that may impede improved patient outcomes;
  • share successful strategies resulting in improved performance and patient care.

Using good evidence

Many of the ACE quality measures have solid evidence behind them, says Robertson. "We have spent a lot of time developing evidence-based practice guidelines with the American College of Cardiology that are considered the gold standard for cardiovascular care, and we are working closely with CMS and JCAHO in that regard, so we will bring forward the same messages," she says.

"We know so much more than we used to, and keeping everything in mind rapidly becomes impossible in modern health care; patients are not in the hospital as long, things are done more rapidly, and we are besieged with guidelines," Robertson notes. "We recognized the need to make things easier for physicians — not harder."

ACE plans to be proactive, she continues. It will identify hospitals that are performing below national averages and contact them, indicating its willingness to help. "We hope to engage these hospitals; there are so many organizations that can help them," Robertson asserts.

As for closing that gap between evidence-based best practices and actual performance, Robertson says the ACE members have learned much about what it takes to succeed. "You need to engage champions in the hospital, who in turn will help engage their colleagues," she says. "You've got to identify the barriers to improvement and talk about how you can overcome them; that's often extremely helpful."

Over the next two years, ACE will announce additional goals to improve the quality of cardiovascular care in focus areas such as discharge instructions for hospitalized patients, appropriate screening for cardiac risk factors in outpatients, and incorporating quality improvement into medical education and certification.

For more information, contact:
Rose Marie Robertson, MD, Chief Science Officer, the American Heart Association, Dallas. Phone: (615) 804-8056.