Author + information
- William A. Zoghbi, MD, FACC, ACC President⁎ ()
- ↵⁎Address correspondence to:
William A. Zoghbi, MD, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037
“Our future will be shaped by the assumptions we make about who we are and what we can be.”
Rosabeth Moss Kanter, America the Principled (1)
Cardiology has made great strides over the last 6 decades in fighting cardiovascular disease—our capacity to diagnose and treat has never been more powerful. Yet the fact is, cardiovascular disease remains the #1 killer around the globe. The College's recently refined mission “to transform cardiovascular care and improve heart health” signals a focus on bettering the health of patients and the population at large. We envision a world of innovation to further enhance care and in which fewer people develop cardiovascular disease in the first place. To this end, the College is working on several fronts; as I take over the helm of the American College of Cardiology (ACC), I would like to offer a glimpse of our major areas of focus for the coming year.
The thematic focus for the ACC in 2012 is patient-centered care, defined by the Institute of Medicine (2) as care that informs and involves patients in medical decision-making and self-management; coordinates and integrates medical care; provides physical comfort and emotional support; understands the patients' concept of illness and their cultural beliefs; and understands and applies principles of disease prevention and behavioral change appropriate to diverse populations. Massive changes to the health care system have forced the cardiovascular community to negotiate rapid shifts on so many fronts, from how we practice to where we practice. To keep the focus on the patient's health, we must be able to effectively communicate and collaborate within and across care teams.
Over the last several years, the ACC has developed several partnerships, programs, and tools to bridge the knowledge gaps between the time-pressed physician and the patient who, along with their family, needs and desires in-depth information and is increasingly expected to play a central role in managing their own heart health. CardioSmart™ is the College-wide initiative that focuses on health, empowers patients with knowledge, and involves them in decisions about their care. This year, CardioSmart.org is being revamped and will be re-launched in early 2013 in a format that enhances access to practical tools. One big improvement is that the redesign will accommodate the latest mobile technology. Our goal is to extend patient education beyond the parameters of the office visit in the hopes of improving understanding, communication, and adherence to management strategies.
At the same time, we are developing robust news and editorial features geared toward patients and their families. We are also sponsoring member-led, community-based events, and programs promoting heart health. Support of the Million Hearts™ campaign also is an integral part of our activities, and in combination with our outpatient PINNACLE Registry®, we should be able to evaluate our intervention on emphasizing the “ABCS” (appropriate aspirin use, blood pressure and cholesterol control, and smoking cessation). Finally, an emphasis on patient-centered care will be disseminated within the College structure by bringing a patient perspective to bear on planning and activities where appropriate.
Education has always been one of the pillars of the ACC. In our efforts to provide the requisite breadth and depth of content to meet the needs of all our members, we are hard at work on several endeavors:
• We will inaugurate our Lifelong Learning Portfolio on CardioSource along with point-of-care tools that provide the clinician a perspective on competency requirements and individual practice gaps using proven learning formats and experiences to drive continual practice improvement. We will also provide Maintenance of Certification tools for both Part II and Part IV to ensure all our members can maintain their competency.
• We will keep all our members abreast of competency requirements.
• We will launch, this year, our first annual curriculum planning process, based on newly published competencies, registry data, and aggregate educational outcomes.
• We are devising an innovative blended learning strategy to support knowledge transfer to practice by delivering a sequence of learning experiences across live and online learning channels.
Our goal is to become the desktop learning destination for cardiovascular care. Our dynamic, personalized website is designed to get “smarter” with every exchange, ultimately enabling us to deliver the right content, in the right format, to the right learner, at the right time.
Science and quality
Foreseeing the benefit of registries for evaluating care, the College instituted the Cath PCI Registry® in 1998. Since then, the National Cardiovascular Data Registry (NCDR®) has grown to 7, the latest being the STS/ACC TVT Registry™ for transcatheter valve replacement—a unique collaborative effort that will likely serve as a paradigm for bringing new technologies into the clinical arena. Almost one-quarter of the College's activities are in registries and this will continue to grow, as data on actual performance and quality will likely be the drivers of outcome and new payment models. Our specific goals are to disseminate tools and best practices for quality improvement programs, including:
• Reducing ST-segment elevation myocardial infarction door-to-balloon times of <90 min (>90% of cases);
• Reducing 30-day readmission rates for heart failure to 22% and acute myocardial infarction to 19%;
• Increasing registered Hospital to Home (H2H) users to 3,000;
• Increasing covered lives under the Imaging in FOCUS program to improve appropriateness in imaging while easing the burden of pre-certification, its associated costs, and wasted resources.
The Science and Quality Division will align ACC quality programs with NCDR data to implement Business Intelligence dashboards that support value-based purchasing. They will also develop mechanisms to transfer physician-specific NCDR quality data into the Lifelong Learning Portfolio. Our goal is for physicians to be able to retrieve and verify their own data. We encourage all our members to take advantage of this program, as public reporting is coming in the not-too-distant future.
For patients to have access to quality care, the practice environment must be able to support physicians and the care team. Unfortunately, the flawed, inappropriately named “Sustainable” Growth rate (SGR) formula—which all experts agree cannot work—is still darkening our professional horizons.
We will keep advocating the repeal of the SGR along with the rest of the house of medicine. As health care undergoes further changes, the ACC is engaged with governmental agencies and payers to develop models that emphasize quality and outcome rather than volume. Examples of such models will be tested through a SMARTCare initiative in Wisconsin and Florida, which has been championed by our ACC Chapter governors and the leadership in health care organizations, payers, and employers in these states. We will also work with state/national policymakers to reduce disparities in care and advocate for tort reform, including certificate of merit and adherence to practice guidelines. The ACC is committed to ensuring that our health care systems are sustainable for all stakeholders, including the health care team.
Finally, as health information technology is becoming an integral part of health care delivery, we will facilitate ACC members' transition to electronic health records. While specific tactics and issues may change—and new situations will likely arise—the issues identified here are ones in which the College can lead change or support cardiovascular professionals as they strive to provide quality care and navigate the new health care challenges.
International membership in the College is at its highest level thus far (13%) and is the fastest-growing section of the College. This coming year, we will exceed 20 international chapters worldwide. The ACC's international strategy touches each mission area of the College, from international participation in ACC meetings and educational courses, to membership and international chapter growth, to international NCDR participation, and of course contributions to our journals and international business opportunities. This coming year we aim to enhance educational engagements between U.S. and international chapters, both through national and international meetings and through our CardioSource and CardioSmart online communities. To this end, we will collaborate internally across the divisions and work with existing international societies along with our diverse international membership to transform cardiovascular care and improve heart health worldwide.
A broad digital strategy and greater interoperability through health information technologies will make it easier than ever before for cardiovascular professionals around the globe to share scientific advances, best practices, and clinical challenges—not to mention download the best educational resources with the touch of a finger. To this end, we are exploring translation of these web-based educational venues into other languages in collaboration with our chapters for greater impact on global health. Whereas in the United States, these technologies will allow us to link adherence to guidelines, appropriate use, and lifelong learning activities with payment and recognition, they present a particular opportunity on a global scale: collecting and reporting data via the NCDR suite of registries can help care teams worldwide not only identify but fix gaps in care.
The health care system in the United States is undergoing major transformation. Our task is to envision the possibilities and turn them into reality. Whatever comes to fruition over the next 12 months and beyond will be a credit to the longstanding and often unrecognized efforts of many individuals—past presidents, executive officers, trustees, and governors, and our wonderful staff and devoted members. Communication with each other, our partner societies, national and global policymakers, patients, industry, payers, consumer groups, and other stakeholders will be key to our future and our success.
In closing, it is an honor and a privilege to serve the College and all of you in helping accomplish our mission. As I do my best to achieve our multifaceted initiatives, I ask you to get involved. Let us question our assumptions and envision a future that includes better health as well as sustainable health care, and figure out how to make that future a reality. I look forward to your support, ideas, and suggestions. Let us identify the possibilities and shape the future of cardiovascular care together.
- American College of Cardiology Foundation
- Kanter R.M.
- ↵Crossing the Quality Chasm: A New Health System for the 21st Century: Committee on Quality of Health Care in America, Institute of Medicine. http://www.nap.edu/catalog/10027.html. Accessed February 27, 2012.