Author + information
- Ralph Brindis, MD, MPH, FACC, ACC President* ( and )
- Mary N. Walsh, MD, FACC, Member, ACC Board of Trustees
- ↵*Address correspondence to:
Ralph Brindis, MD, MPH, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037
In its report “Crossing the Quality Chasm: A New Health System for the 21st Century” (1), the Institute of Medicine outlined specific aims for the improvement of health care. These 6 core principles described health care that is safe, effective, patient-centered, timely, efficient, and effective. Patient-centered care is further defined as “care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (1). Although many physicians have argued that care has always been patient-centered, the recent move toward such care is a distinct change from the historic model of care that was predominantly provider-centered.
Attributes of Patient-Centered Care
Davis and others from the Commonwealth Fund (2) have identified 7 attributes that are necessary for patient-centered care:
1. Access to care;
2. Patient engagement;
3. Clinical information systems that support high-quality care, practice-based learning, and quality improvement;
4. Care coordination;
5. Integrated and comprehensive team care;
6. Routine patient feedback to doctors; and
7. Publicly available information.
The American College of Cardiology (ACC)'s Initiatives in Patient-Centered Care
In an effort to begin addressing issues in patient communication, education, and engagement, the ACC Board of Trustees approved the first phase of the CardioSmart initiative in 2007. The CardioSmart.orgwebsite was launched in March 2008 at the ACC.08 Annual Meeting. The purpose of CardioSmart.orgis to provide comprehensive, thorough, and authoritative informational and educational resources as well as interactive management and compliance tools for heart disease patients and their families.
Most ACC members have heard of CardioSmart—in fact, you may have recommended it to your patients as a great website for learning more about cardiovascular conditions. But, CardioSmart is now much more than just a website. CardioSmart is the term for ACC's patient-centered activities, and it encompasses a number of patient outreach efforts that the ACC is making on behalf of its members.
Year of the Patient (YOP) and the Patient-Centered Care Committee (PC3)
In March 2009, under ACC President Alfred Bove, MD, MACC, the College launched the YOP. The purpose of the YOP was to develop a framework and a strategic plan to allow the ACC to become a leader in the area of patient-centered care. Dr. Bove initially appointed a Patient-Centered Care Work Group, which was subsequently made into a formal committee by the Board of Trustees in August 2009.
The PC3 is composed of a steering committee that includes a broad representation from all ACC initiatives including education, advocacy, and quality and from member sections including fellows in training and practice administrators. Importantly, the steering committee will also include patients as active members. Several PC3 subcommittees have also been formed including Community Engagement, Strategic Business Partnerships, and the Patient-Centered Medical Home.
The PC3 is charged with transforming the care experience and improving health outcomes for people with heart disease through the development of partnerships, programs, and tools that support care that intentionally draws the patient and family members into the care process through clinician-facilitated patient engagement (i.e., information sharing, patient participation, and care collaboration). The committee serves to enhance the provider–patient relationship and bridge the gap that currently exists between clinician communications and patient/family understandings of their critical roles in managing their heart health.
The goals of the PC3 include:
1. Make care patient-centered;
2. Strengthen the provider–patient relationship;
3. Engage and educate patients to be partners in care;
4. Provide a virtual office for the provider–patient encounter;
5. Provide necessary elements to transform the care experience; and
6. Recommend ACC's strategy for the cardiovascular specialist's participation in the Patient-Centered Medical Home health care delivery model.
The elements required to accomplish these goals are:
1. Delivery of practical tools and information for use in member clinician offices and via a comprehensive, web-based platform;
2. Execution of robust news and editorial features geared for patients and their families;
3. Sponsorship of member-led, community-based events and programs promoting cardiovascular health; and
4. Collaboration with strategic external partners to allow broader dissemination of the PC3-developed practical tools and patient-centered information.
The College has established stringent principles of engagement with any strategic partners. Our partners must show a substantial and credible commitment to CardioSmart goals and objectives and offer products and/or services that relate to encouraging heart-healthy behaviors. All partnerships must be approved through the ACC's review process, which includes initial approval by the PC3 followed by approval from the Executive Committee of the Board of Trustees. Partnership will not require or expect any endorsement by the ACC, either actual or implied, of any product or service. These important strategic partnerships will greatly help support our ability to educate patients through the dissemination of our patient-centered care program.
CardioSmart in 2010 and beyond
As of this year, the CardioSmart.orgwebsite has been integrated into the broader patient-centered ACC activities. The CardioSmart initiative is starting to extend beyond the office visit with community events, web-based education, tracking modules, and discounts for heart-healthy products. One such community event, CardioSmart Atlanta, was sponsored by the Georgia Chapter and held in conjunction with the ACC.10/i2 Summit. The event included blood pressure screenings, cooking demonstrations, heart healthy kids' activities, and loads of educational presentations and products. CardioSmart Atlanta is serving as a template for similar community events in other chapters. Through interaction with the Board of Governors and Cardiac Care Associate chapter liaisons, patient-centered care is becoming a focus of many chapter activities, and this trend is expected to continue.
Moving forward, the CardioSmart.orgwebsite will continue to be a key component of the CardioSmart initiative. The site offers information on risk factors and specific conditions as well as on diagnostic tests and treatments patients may encounter; online blood pressure and condition tracking; a video library; patient stories; and more. CardioSmart.orgcan literally serve as an extension of the office or hospital visit to allow you to continue the partnership with your patient outside the examination room. With you directing your patients toward these tools and activities, the goal is greater patient engagement, both in their relationships with you and the other members of the cardiovascular care team, and in their own health.
Beyond the website, the ACC will continue to work with national partners to help deliver CardioSmart strategies to people at risk for heart disease. With the support of one such partner, starting this September the California Chapter is piloting a CardioSmart hypertension program designed to produce measurable improvement of patients' understanding of their cardiovascular health, as well as improved hypertension outcomes.
The pilot depends on ACC members to recruit patient participants. ACC members will provide patients with hypertension education materials and prompt them to register for the pilot at CardioSmart.org, where they will have the opportunity to view additional education material and begin tracking their blood pressure online with the CardioSmart heart health tracker. Patients will receive electronic prompts and reminders as well as opportunities to earn rewards—pedometers, t-shirts, coupons, and so on. Key metrics are physician/practice adoption and patient enrollment rates, as well as the sustainability of the program in terms of patients' willingness to track their blood pressure for an extended period of time. The benchmark of patients' blood pressures compared with guideline-recommended targets will serve as an outcome measure.
The PC3 will also continue to look for new ways to integrate the patient perspective into all ACC activities and to provide members with information to aid the development of a more patient-centered style of practice. The development of guidelines and performance measures for a patient audience as well as clinical decision support tools to aid in shared decision making is in the works. Stay tuned for more information on the evolution of the CardioSmart campaign.
The broadening of the CardioSmart initiative signals a new ACC focus on patient-centered care and acknowledges the needs of members by providing timely and accurate tools and information to their cardiovascular patients. The ACC is quite excited about these novel endeavors that promote cardiovascular health, empower the patient to be even more proactively involved in his or her care, and strengthen the patient–clinician relationship. We encourage all of our members to direct their patients to the College's CardioSmart program. We hope that you personally find this initiative to be a valuable asset for your own practice with its promotion of the Institute of Medicine's ideals of patient-centered care.
- American College of Cardiology Foundation