10/18/2010 1 CME Partnering with Quality Improvement to Reduce Disparities in Cardiovascular Disease Outcomes: A credo Initiative Laura Lee Hall, Ph.D. Director, Strategic Educational Initiatives Diversity Rx Baltimore, MD October 20, 2010 Disclosures No financial conflicts of interest to disclose Presentation Objectives: • Provide context: A brief introduction to the ACC’s education and quality efforts • Summarize relevant programs: credo and Keeping PACE • Discuss early experience and strengths of the program What Is ACC? ACC Membership 38,184 Members -89% domestic -11% international -10% FITs -11% CCAs Specialty Breakdown -57% General Cardiology -20% Interventional Cardiology -5% Electrophysiology -5% Pediatric Cardiology National Cardiovascular Data Registry (NCDR) For diagnostic cardiac catheterizations and percutaneous coronary interventions For acute coronary syndrome patients For carotid artery revascularization and endarterectomy procedures For implantable cardioverter defibrillators For improving pediatric and adult congenital treatment Nation’s largest ambulatory care cardiovascular quality improvement registry
Transcript
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CME Partnering with Quality Improvement to Reduce Disparities in
Cardiovascular Disease Outcomes: A credo Initiative
Laura Lee Hall, Ph.D.Director, Strategic Educational
Initiatives
Diversity RxBaltimore, MD
October 20, 2010
Disclosures
No financial conflicts of interest to disclose
Presentation Objectives:
• Provide context: A brief introduction to the
ACC’s education and quality efforts
• Summarize relevant programs: credo and
Keeping PACE
• Discuss early experience and strengths of
the program
What Is ACC?
ACC Membership
38,184 Members
-89% domestic
-11% international
-10% FITs
-11% CCAs
Specialty Breakdown
-57% General Cardiology
-20% Interventional Cardiology
-5% Electrophysiology
-5% Pediatric Cardiology
National Cardiovascular Data Registry (NCDR)
For diagnostic cardiac catheterizations and percutaneous coronary interventions
For acute coronary syndrome patients
For carotid artery revascularization and endarterectomy procedures
For implantable cardioverter defibrillators
For improving pediatric and adult congenital treatment
Nation’s largest ambulatory care cardiovascular quality improvement registry
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ACTION Registry®-GWTG™ Demographics, 2009
ACTION Registry®-GWTG™: Distribution of Race and Gender, 2009
Sources: U.S. Census Bureau, 2006-2008 American Community Survey
• Slightly whiter patient group in PINNACLE unsurprising, given age of patients
• Blacks appear overrepresented relative to U.S. population, perhaps due to higher incidence of cardiac disease
• Clear opportunity for future data analysis of Hispanic population in PINNACLE database (information is collected but not currently reported)
85.0%
14.2%
0.7%
74.3%
15.1%12.3%
4.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
White Hispanic Black Asian
Sh
are
of
Pati
en
t E
nco
un
ters
PINNACLE U.S.
Distribution of Data-submitting Practices
PI-CME: A Model for Integrating Quality and Education• Adopted for credit by the AMA in 2005• Goal-oriented, long-term structured educational model• Three stages:
– Stage A: Assessment: Assess current practice based on valid performance measures – 5 CME credits
– Stage B: Education: Apply educational tools and strategies designed to close identified performance gaps – 5 CME credits
– Stage C: Reflection: Reflect and re-evaluate changes in practice performance and outcomes – 5 CME credits
Completion of entire activity leads to 5 more CME credits for a total of 20
ABIM Maintenance of Certification MOC Part I: Professional Standing – Current,
unrestricted medical license
MOC Part II: Lifelong Learning and Periodic Self-Assessment – Options include the ABIM’s 60-multiple choice question self-assessment Knowledge Modules or the ACCF self-assessment program, ACCSAP
MOC Part III: Cognitive Expertise –Recertification examination every 10 years
MOC Part IV: Practice Performance Assessment –Evaluation of practice improvement
• Ease collection of practice data
• Combine provider and patient education
as well as QI tools
• Use a powerful but easy-to-use web-
based platform
• Provide comparable credits for nurses,
and
• Provide eligibility for MOC part IV credit
ACC PI-CME Seeks to:At the Base of Performance Improvement Education
Educational planning driven by data-based gap
analysis
Individual practice gaps identified through data
Educational design based on evidence-based adult learning
principles
Content based on research and evidence-
based guidelines
Data
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ACC Programs Must Work for Members: Clinician-centered
- Ease of implementation- Satisfies multiple requirements
• Major goal is to identify, develop, and disseminate evidence-based tools and
educational activities that will promote CVD care and outcomes equity
• Achievements in year one include several live and online educational programs, publication of a white paper, and launch of a website
Advisory Group Members
Clyde W. Yancy, MD, FACC, FAHA, MACP– Co-ChairBaylor Heart and Vascular InstituteBaylor University Medical Center
Hector O. Ventura, MD, FACC, FACP, FASH – Co-ChairNational Hispanic Cardiologists Leadership NetworkTulane University School of Medicine
Tracy Y. Wang, MD, MHS, MSc, FACC –Co-ChairDuke Clinical Research Institute
Dee Baker Amos Cultural Health Initiatives
American Heart Association
Paul N. Casale, MD, FACCChapter President, Pennsylvania ACC
Lancaster General Hospital
Paul S. Chan, MD, MScMid America Heart Institute
Marshall Chin, MD, MPH Finding Answers: Disparities Research for
Change University of Chicago
Adolph P. Falcón, MPPThe National Alliance for Hispanic Health
Keith C. Ferdinand, MD, FACC, FAHAEmory University
Association of Black Cardiologists , Inc.
Gordon L. Fung, MD, MPH, PhD, FACCUCSF
Governor, Northern CA, ACCPresident, California Chapter, ACC
Tawara D. Goode, MANational Center for Cultural Competence
Georgetown University Center for Child & Human Development
Marcia Jackson, PhDCME by Design
Robert C. Like, MD, MSCenter for Healthy Families and Cultural
DiversityUMDNJ-Robert Wood Johnson Medical School
Aravinda Nanjundappa, MD, FACC, FSCAI, RVTWest Virginia University
Eric D. Peterson, MD, MPH, FACC, FAHADuke University Medical Center
Duke Clinical Research Institute
Ileana L. Piña, MD, MPH, FACC, FAHANational Hispanic Cardiologists Leadership
NetworkCase Western Reserve UniversityLouis Stokes VA Medical Center
Sarah H. Scholle, DrPH, MPHNational Committee for Quality Assurance
Advisory Group Members, continued
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Yabiz Sedghi, MDChief Cardiology Fellow
Ochsner Clinic Foundation
Joanna D. Sikkema, MSN, ARNPUniversity of Miami
Whole Health ManagementPresident ElectPreventive Cardiology Nurses Association
Krishnaswami Vijayaraghavan, MD, MS, FACC, FACPChapter President-Elect/ACC Governor-Elect for ArizonaScottsdale Clinical Research Institute
Karol E. Watson. MD, PhD, FACC, FAHADavid Geffen School of Medicine at UCLA
Advisory Group Members, continued
Program Support
• credo sponsors:
• Additional independent educational grant support
for credo educational initiatives have been provided by:
• AstraZeneca, Daiichi Sankyo, Inc., Eli Lilly USA, LLC, Medtronic, and Novartis
credo: Why, What and How
• CVD disparities exist and lead to
avoidable, premature morbidity and mortality
• Trends in population and cardiology compound CVD disparities
• Evidence-based approach to reducing disparities available for further testing and
implementation
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What Works in Reducing Disparities?
• Data-driven performance improvement
• Provider education
• Team-based care
• Patient education
• Community resources
credo Pathway to CVD Outcome Equity
Data from Your Hospital by Race
llh1
National Minority Quality Forum, the American College of Cardiology, and the Association of Black Cardiologists, with generous support from Novartis Pharmaceuticals Corporation
Canton, OH Heart Disease Rate by Race/Ethnicity
Your Hospital’s Performance
34%
78%
97%
0%
20%
40%
60%
80%
100%
120%
Cardiac rehabilitation
% A
dm
issio
ns
Hospital Nation Top 10%
Q3 2009 ACTION Registry®-GWTG™ data report
System-level
• Automatic referral protocols
• Use of performance measures & evidence-based guidelines
• Program structure & accessibility
• AACVPR certification
• Accountability• Reimbursement• Distance to program• Access to preventive
resources in the community
Patient-level
• Age, race, gender• Marital status, education
level, transportation• Work flexibility, family
responsibilities• Motivation, lack of awareness
• Insurance, co-pay
• Knowledge, attitudes, beliefs
• Lack of physician endorsement
• Expectations of family, friends
• Psychological factors
• Exercise painful & tiring
Provider-level
• Competing cardiologist & hospital
• Skepticism of benefit of CR
• Preference to treat personally
• Physician attitudes• Time consuming referral
process-availability of resources (forms, personnel)
• Intention, self-efficacy
• Perceived need
Factors Leading to Underutilization of CR and Role of PI
Sanderson, BK, JCR 2005; 25:350-353; Suaya, J et al. Circulation 2007:116; Grace, S. et al. J of Women’s health. 2009: 18
Addressed by QI tools in Keeping
PACE
Addressed by patient
education tools in
Keeping PACE
Addressed by provider
education tools in
Keeping PACE
Slide 39
llh1 prototype to be tailored for the hospitalLaura Lee Hall, 8/4/2010
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Gap-driven and Impactful Patient Education
http://www.cardiosource.org/credo
Education is Part of the CurePatrick O’Gara, MD, FACC
