ACE aims to help lower performing facilities
Focus is on seven core heart care measures
Hospital CEOs and administrators from the lowest performance quartile on seven core heart care measures targeted by the Alliance for Cardiac Excellence (ACE) recently have been receiving letters and information on resources available to help them improve.
Using data from July 2004 through June 2005 from Hospital Compare (www.hospitalcompare.hhs.gov/), a quality tool provided by the U.S. Department of Health and Human Services, ACE identified hospitals with lower than average scores for heart attack and heart failure treatment.
Improving outcomes
In correspondence to leaders of these hospitals, ACE explained that its members were committed to helping them improve outcomes for cardiac patients through established tools and resources.
ACE includes 29 health care organizations working together to bridge the gap between nationally accepted standards of care and the actual care many adult cardiac patients currently receive. In June, ACE announced its goal to ensure that 95% of all hospitals provide care meeting seven core quality measures for heart attack and heart failure patients by the end of 2006. Those seven measures include:
- For patients with a heart attack (acute myocardial infarction, or AMI): aspirin at arrival, aspirin prescribed at discharge, ACEI (angiotensin converting enzyme inhibitor) or ARB (angiotensin receptor blocker) for LVSD (left ventricular systolic dysfunction), beta-blocker prescribed at discharge, and beta-blocker at arrival.
- For patients with heart failure: LVF assessment and ACEI or ARB for LVSD.
Getting their attention
"There are a couple of powerful ways to motivate providers and their governing bodies to redouble their efforts to improve their quality performance," notes David Schulke, executive vice president of the American Health Quality Association (AHQA), which, along with the Centers for Medicare & Medicaid Services (CMS), is a founding member of ACE. "One method is to publicize performance, especially high performance, because that has some commercial value and is a matter of pride in the culture of the institution."
For facilities that have not performed well, he continues, "There is another powerful motivator that suggests a public disclosure could come later — but not now. Such an approach can be used to send someone a communication that says, 'We are aware from monitoring the data that yours is not one of the higher performing institutions, and we want to call your attention to this fact.'"
This, says Schulke, can be a powerful motivator for improvement. "Everyone knows qualify performance is being made public," he observes. "To give someone a heads up, and say you know there's a problem — but here's someone with help — is a good message to the institution."
Having received such a message, he continues, such facilities "should make strenuous efforts to be self-critical and improve, and to ask for help."
While the message is friendly in tone, he explains, "It gives them a serious nudge, while implying there could be more later." (ACE provides a list of resources to help hospitals improve their performance at www.ofmq.com/ace.html.)
People are the problem
The challenge in improving cardiac care is not that people don't know what works, says Schulke. "The things people need to do to improve quality are often simple procedures, but [what's hard is] getting people organized to do things — and to reliably do them every time a patient comes in the hospital."
The procedures themselves are much less complicated, and in theory all hospitals have clinical pathways and procedures to perform every time a patient is thought to be in heart failure, he notes. "They look relatively simple on paper, but getting people to sit down in a busy day to agree to this, to decide who is involved and exactly what they should do is very difficult," says Schulke. "That's because it involves getting busy people together who are separated by training, temperament, and so forth. That's why it's important to have a supportive culture that begins at the top — and I mean the board."
Key resources
Among the key resources hospitals can turn to for help in meeting this challenge, says Schulke, are the quality improvement organizations, or QIOs. (Under the direction of CMS, the program consists of a national network of 53 QIOs, responsible for each U.S. state, territory, and the District of Columbia.)
"They work on the same measures and know a lot about how to get people together," Schulke explains. Unfortunately, he adds, their ability to help is limited. "CMS can only afford to have QIOs work with 15% of the hospitals on this, so at present not all of them can be helped," he notes.
To remedy the situation, AHQA has recommended that current law be changed to allow QIOs to work for providers that can and are willing to pay for their help. "It's not good or wise for Medicare to knowingly not fund this adequately, and at the same time prevent QIOs from working privately to ensure all the hospitals that want help get it," he asserts.
Meanwhile, ACE is moving forward with other initiatives. In January 2007, its members will begin focusing on smoking cessation advice/counseling, thrombolytic agent received within 30 minutes of hospital arrival, PCI (percutaneous coronary intervention) received within 120 minutes of hospital arrival for AMI patients, and discharge instructions and smoking cessation advice/counseling for HF patients.
For additional information, contact:
David Schulke, Executive Vice President, The American Health Quality Association, 1155 21st Street NW, Suite 202, Washington, DC 20036. Phone: 202-331-5790.
Hospital CEOs and administrators from the lowest performance quartile on seven core heart care measures targeted by the Alliance for Cardiac Excellence (ACE) recently have been receiving letters and information on resources available to help them improve.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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