Symposium on Stem Cell Therapy and Cardiovascular Innovations
Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium
-
Upload
stjosephsmedicalcenter -
Category
Documents
-
view
71 -
download
0
Transcript of Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium
![Page 1: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/1.jpg)
Brief Overview of the American College of Cardiology
John Gordon Harold, MD MACC, MACP, FESC, FAHA
President Elect American College of Cardiology
February 9, 2013
![Page 2: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/2.jpg)
ACC Leadership 2013 President: Dr. William Zoghbi
President-Elect: Dr. John Gordon Harold
Vice President: Dr. Patrick O’Gara Immediate Past President:
Dr. David Holmes Chair BOG: Dr. Dipti Itchhaporia Treasurer: Dr. Michael Valentine
![Page 3: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/3.jpg)
American College of Cardiology 64 Years of Quality and Education
1949-2013
Heart House, Washington D.C.
![Page 4: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/4.jpg)
The American College of Cardiology
![Page 5: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/5.jpg)
The Mission of the ACC
To Transform
Cardiovascular Care and Improve
Heart Health
![Page 6: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/6.jpg)
Invitation to San Francisco
ACC.13
![Page 7: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/7.jpg)
Choosing Wisely: Appropriate Use Criteria,
Maintenance of Quality, and Cost Effective Practice
St. Joseph's Medical Center Cardiac Symposium - February 9, 2013
Stockton Golf and Country Club in Stockton, California
![Page 8: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/8.jpg)
Presenter Disclosure Information for John Gordon Harold, MD MACC, MACP, FESC, FAHA
Clinical Professor of Medicine David Geffen School of Medicine at UCLA
and Cedars-Sinai Heart Institute Los Angeles, California
No relationships to disclose
![Page 9: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/9.jpg)
• Appropriate Use Criteria (AUC): The development of appropriateness criteria - including something of the history behind them and the practicalities of their development
• Choosing Wisely Campaign: Avoiding Avoidable Care: Choosing Wisely in Cardiovascular Medicine
![Page 10: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/10.jpg)
Is This Appropriate?
1978 Portland, Oregon Art Campaign Mayor of Portland
![Page 11: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/11.jpg)
Is This Appropriate?
1978 Portland, Oregon Art Campaign
![Page 12: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/12.jpg)
Is This Appropriate? Not really
![Page 13: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/13.jpg)
1 .30 to 2 .97 (57) 1 .1 to < 1 .30 (47) 0.9 to < 1 .10 (83) 0 .75 to < 0 .90 (51) 0 .35 to < 0 .75 (68) Not Populated
But is this Appropriate? Variation in rates of PCI - USA
Source: Dartmouth Atlas
![Page 14: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/14.jpg)
Variation in Rate of Inappropriate PCI Procedures in Non-Acute Indications
Chan P el al. JAMA 2011; 306:53
![Page 15: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/15.jpg)
JULY 6, 2011
Heart Treatment Overused Study Finds Doctors Often Too Quick to Try Costly Procedures to Clear Arteries
Or This Appropriate?
Feds Probe HCA for Unnecessary Stenting By Chris Kaiser, Cardiology Editor, MedPage Today Published: August 07, 2012 A Florida nurse's complaint has led to a federal probe of potentially unnecessary cardiac procedures at HCA Holdings, the largest for-profit hospital chain in the U.S., according to news reports. At Lawnwood Regional Medical Center in Fort Pierce, Florida, for example, about 1,200 cardiac catheterizations were deemed to be unnecessary, according to a report in the New York Times.
![Page 16: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/16.jpg)
Explosion in Cardiovascular
Technology
![Page 17: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/17.jpg)
Geographic Variation in the United States -Utilization of Noninvasive Diagnostic Imaging: Medicare Data, 1998–2007
![Page 18: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/18.jpg)
Growth in Advanced Imaging CT, MR, and PET
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Serv
ices
per
1,0
00 M
edic
are
Bene
ficia
ries
CT MR PET
0
20
40
60
80
100
120
140
160
180 CT MR PET All Modalities
Cardiology Overall
Source: http://oig.hhs.gov/oei/reports/oei-01-06-00260.pdf.,
![Page 19: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/19.jpg)
$0
$200,000,000
$400,000,000
$600,000,000
$800,000,000
$1,000,000,000
$1,200,000,000
$1,400,000,000
1998 2000 2002 2004 2006 2008 2010
MPS
Echo
ETT
Cath
Medicare Physician Payments for SPECT , Echo, Cardiac Cath, and ETT
www.cms.gov/DataCompendium/. Leslee S, Marwick T, Zoghbi W et al. JACC Img 2010
![Page 20: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/20.jpg)
8.1% 8.5% 8.5% 8.7% 9.0% 9.1% 9.4% 9.9% 10.4% 10.5% 10.5% 10.7% 11.1% 11.2%
16.0%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
As P
erce
ntag
e of
GD
P Total Health Care Expenditure as a
Share of Gross Domestic Product (GDP) United States and Selected Countries, 2008
Australia 8.5% United States
16 %
Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.
![Page 21: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/21.jpg)
2013 >$10 Trillion
US Deficit
![Page 22: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/22.jpg)
Avoidable Care and Waste- Contributing Factors • Abundance of imaging & other technologies
(accuracy, detailed anatomy & physiology)
• Complex disease- comorbidities
• Greater patient awareness, demand for latest technology
• Fragmentation of care (repeat testing)
• Defensive medicine
• Demise of the physical examination (Generalist and Specialist)
• Fee for service model (incentive for overutilization)
• Futility & end of life issues
![Page 23: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/23.jpg)
Donald M. Berwick, MD, MPP; Andrew D. Hackbarth, MPhil . JAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362
Waste in US Health Care
![Page 24: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/24.jpg)
![Page 25: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/25.jpg)
Unintended Variation and Waste in Healthcare
• Dr. Donald Berwick:
“We basically have two economic health care options- We can cut care… Or we can improve care.”
![Page 26: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/26.jpg)
The National Strategy for Quality Improvement in Health Care’s
TRIPLE AIM
Better care 1
2
3
Healthy people/communities
Affordable care To preserve our specialty’s autonomy the ACC needs to provide direction and leadership with Guidelines, Performance Measures and Appropriate Use Criteria to achieve the “Triple Aim” in Cardiovascular Care.
![Page 27: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/27.jpg)
The Appropriateness Imperative 2013 - Challenges for the Profession
• Changes in cardiovascular practice and health care reform in the United States and abroad
• Demand for measurement of quality • Demand for public reporting and transparency • Demand for assuring responsible diffusion of
cardiovascular innovation • Demand for appropriate use
![Page 28: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/28.jpg)
Professionalism
![Page 29: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/29.jpg)
Why Appropriate Use Criteria?
Professional Responsibility
Commitment to
Quality
Components of quality…include appropriateness of case selection…
A quality program performs appropriately selected procedures…
- 2005 ACC/AHA/SCAI PCI Guidelines
We can do it better than anyone else
![Page 30: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/30.jpg)
Appropriate Use Criteria (AUC) History (2004-2005)
• RAND/UCLA Appropriateness Criteria (1990’s)
• ACC’s Medical Directors’ Institute.
• ACC State Chapter requests for ACC National action based on Payer challenges and Redding, California PCI/CABG reviews.
• ACC Board of Governors encouraged.
development of appropriate use criteria.
• American College of Radiology and payers defining imaging growth and cost.
![Page 31: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/31.jpg)
ACC Board of Governors • Elected Governors – All 50 United States,
Territories, Military, Veterans Administration, Public Health, Canada and Mexico.
• Voice of the collective ACC membership.
• Diverse specialties/demographics.
• Majority are in private practice.
• Educates members on ACC initiatives.
![Page 32: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/32.jpg)
ACC Appropriate Use Criteria Goals • The College will partner with clinicians, health plans,
payers and policymakers for rational/fair use and reimbursement for heart disease
• Blend evidence-base and clinical experience data, congruent with clinical practice guidelines
• Recognize that some ambiguity is intrinsic to clinical decision making
• AUC is not a substitute for sound clinical judgment or patient preference
• Steward equitably and efficiently limited United States health care resources
![Page 33: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/33.jpg)
Definition of Appropriate Use • An appropriate diagnostic or therapeutic procedure is one in
which the expected clinical benefit exceeds the risks of the procedure by a sufficiently wide margin such that the procedure is generally considered acceptable or reasonable care.
• For diagnostic imaging procedures, benefits include- incremental information which when combined with clinical judgment - augment efficient patient care, and the expected negative consequences (risks include the potential hazard of missed diagnoses, radiation, contrast, and/or unnecessary downstream procedures.
• For therapeutic procedures such as revascularization or ICD/CRT, the benefits include survival or health outcomes (such as improved symptoms, functional status, and/or quality of life) weighed against the risks of the procedure and subsequent related care.
![Page 34: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/34.jpg)
What are Appropriateness Criteria? • Appropriate Use Criteria (AUC) define “what to
do”, “when to do”, and “how often to do” in the context of local care environments combined with patient and family preferences and values
• Address misuse, overuse and underuse
• Connected to guideline content
• Imply a level of detail and complexity that extends beyond the current recommendations
![Page 35: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/35.jpg)
AUC - “The Preface” 1. AUC blends evidence-base and clinical experience and is
concordant with Clinical Practice Guidelines
2. We recognize that some ambiguity is intrinsic to clinical decision making and that AUC is not a substitute for sound clinical judgment nor patient preference
3. Where practice patterns of individuals, groups or hospitals routinely conflict with AUC ratings, further evaluation and education, with tracking and feedback, should be considered
4. These terms were originally adopted from the RAND criteria and chosen after review and debate of various approaches for examining use of technology across various clinical populations.
![Page 36: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/36.jpg)
RAND/UCLA AUC Methodology Based on Modified Delphi Process
![Page 37: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/37.jpg)
APPROPRIATE USE CRITERIA Appropriate Use of Cardiovascular Technology: 2012
Appropriate Use Criteria Methodology Update A Report of the American College of Cardiology Foundation
Appropriate Use Criteria Task Force • Robert C. Hendel, MD,
FACC, FAHA, FASNC
• Manesh R. Patel, MD, FACC
• Joseph M. Allen, MA
• James K. Min, MD, FACC
• Leslee J. Shaw, PhD, FACC, FASNC, FAHA
• Michael J. Wolk, MD, MACC
• Pamela S. Douglas, MD, MACC, FAHA, FASE
• Raymond F. Stainback, MD, FACC, FASE
• Christopher M. Kramer, MD, FACC, FAHA
• Steven R. Bailey, MD, FACC, FSCAI, FAHA
• John U. Doherty, MD, FACC, FAHA
• Ralph G. Brindis, MD, MPH, MACC, FSCAI, ex officio
![Page 38: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/38.jpg)
Appropriateness Definitions • Appropriate: generally acceptable and are a
reasonable approach for the indication.
• May be Appropriate Care (Uncertain): may be a reasonable approach for the indication. Does not mean Inappropriate and should be reimbursable.
• Rarely Appropriate Care (Inappropriate): is not generally a reasonable approach for the indication. - Does not mean fraud.
![Page 39: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/39.jpg)
Median Score 7 to 9: Appropriate Care • An appropriate option for management
of this patient population due to benefits generally outweighing risks; effective option for individual care plans although not always necessary depending on physician judgment and patient specific preferences (i.e., procedure is generally acceptable and is generally reasonable for the indication).
![Page 40: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/40.jpg)
Median Score 4 to 6: May Be Appropriate Care
• At times an appropriate option for management of this patient population due to variable evidence or agreement regarding the benefits risks ratio, potential benefit based on practice experience in the absence of evidence, and/or variability in the population; effectiveness for individual care must be determined by a patient’s physician in consultation with the patient based on additional clinical variables and judgment along with patient preferences (i.e., procedure may be acceptable and may be reasonable for the indication).
![Page 41: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/41.jpg)
Median Score 1 to 3: Rarely Appropriate Care
• Rarely an appropriate option for management of this patient population due to the lack of a clear benefit/risk advantage; rarely an effective option for individual care plans; exceptions should have documentation of the clinical reasons for proceeding with this care option (i.e., procedure is not generally acceptable and is not generally reasonable for the indication).
![Page 42: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/42.jpg)
Guidelines, Performance Measures & AUC: How Do They Differ?
• Guidelines: Synthesize evidence and recommend range of generally acceptable approaches for the diagnosis, management or prevention of conditions/diseases.
• Performance Measures: Specific clinical measures indicative of high-quality, evidence-based care
• AUC: Define the “when to do” and “how often to do” a given procedure in the context of scientific evidence – incorporates cost factors as well
![Page 43: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/43.jpg)
Science tells us what we can do;
Guidelines what we should do;
Registries what we are actually doing.
![Page 44: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/44.jpg)
Translating Evidence Into High-Value Care
Antman, Circulation 2009:119:1180-1185. Antman, Circulation 2009:119:1180-1185.
![Page 45: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/45.jpg)
• SPECT-MPI • CCT/MRI • TTE/TEE • Stress Echocardiography • Coronary Revascularization:
PCI/CABG • SPECT-MPI Update • Diagnostic Cath • Peripheral Vascular Disease • Pacemaker/ICD (2013) • Multimodality (2013)
Appropriate Use Criteria (AUC)
![Page 46: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/46.jpg)
J Am Coll Cardiol 2009; 53;530-553 Available at http://www.acc.org
"An effort to insert clinical rationality…"
AUC For Coronary Revascularization
![Page 47: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/47.jpg)
AUC Account for an Array of Scenarios Revascularization Appropriateness
Non-invasive testing
Symptoms/Rx
Burden of disease
![Page 48: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/48.jpg)
Some Variation May be Warranted Defining Measures of Appropriateness
AUC Task Force!!
![Page 49: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/49.jpg)
AUC: Implementation and Evaluation New Technology
• Migration towards point-of-order
• Embedded clinical decision support
• Tracking/data registry
• Reporting/feedback
Need to Engage Physicians beyond Cardiology…
![Page 50: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/50.jpg)
AUC Conclusions • Winston Churchill one said: “The farther backward you
can look, the farther forward you can see.”
• Appropriate Use Criteria (AUC) were developed to review patterns of care and serve as a framework for assessing appropriateness of care. The vast majority of cardiologists are caring doctors who work hard to stay informed and make the best decisions for their patients.
• Even with established criteria, treatment decisions are complex and involve patient preferences and individual circumstances. The best decisions come from an informed doctor, an informed patient and an open dialogue.
![Page 51: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/51.jpg)
Choosing Wisely is an initiative of the ABIM Foundation to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices. Shared decision making…
![Page 52: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/52.jpg)
Medicine's Ethical Responsibility for Health Care Reform — The Top Five List
“A Top 5 list also has the advantage that if we
restrict ourselves to the most egregious causes of waste, we can demonstrate to a skeptical public that we are genuinely protecting patients’ interests and not simply ‘rationing’ health care, regardless of the benefit, for cost-cutting purposes.”
Howard Brody, MD, PhD
New England Journal of Medicine
![Page 53: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/53.jpg)
Components of the Choosing Wisely Campaign
• Messengers and Collaborators 34 specialty societies and Consumer Reports—
and growing • Communicate Messages Specialty societies, Consumer Reports, consumer
organizations and ABIM Foundation • Activate Concrete action around unnecessary tests and
procedures
![Page 54: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/54.jpg)
Choosing Wisely Partners Societies Developing Lists • American Academy of Hospice and Palliative
Medicine • American Academy of Neurology • American Academy of Ophthalmology • American Academy of Orthopaedic Surgeons • American Academy of Otolaryngology-Head and
Neck Surgery • American Academy of Pediatrics • American College of Chest Physicians • American College of Obstetricians and
Gynecologists • American College of Rheumatology • American College of Surgeons • American Geriatrics Society • American Headache Society • AMDA • American Society for Clinical Pathology • American Society of Echocardiography • American Society of Hematology • American Society for Radiation Oncology • American Urological Association • North American Spine Society • Society of Cardiovascular Computed Tomography • Society of General Internal Medicine • Society of Hospital Medicine • Society of Nuclear Medicine and Molecular Imaging • Society of Thoracic Surgeons • Society of Vascular Medicine
Societies Developed Lists • American Academy of Allergy Asthma &
Immunology • American Academy of Family Physicians • American College of Cardiology • American College of Physicians • American College of Radiology • American Gastroenterological Association • American Society of Nephrology • American Society of Nuclear Cardiology • American Society of Clinical Oncology • National Physicians Alliance
Consumer Groups Through Partnership with Consumer Reports • AARP • Alliance Health Networks • Leapfrog Group • Midwest Business Group on Health • Minnesota Health Action Group • National Business Coalition on Health • National Business Group on Health • National Center for Farmworker Health • National Hospice and Palliative Care Organization • National Partnership for Women & Families • Pacific Business Group on Health • SEIU • Union Plus • Wikipedia
![Page 55: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/55.jpg)
Choosing Wisely in the Media
![Page 56: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/56.jpg)
How ACC Created Its List • The American College of Cardiology asked its standing
Clinical Councils to recommend between three and five procedures that should not be performed or should be performed more rarely and only in specific circumstances.
• ACC staff took the councils’ recommendations and compared them to the ACC’s existing appropriate use criteria (AUC) and guidelines, choosing items for the five things list that had the tightest inappropriate score in the AUCs and were Class III (risk > benefits) recommendations in the guidelines.
• The ACC’s Advocacy Steering Committee and Clinical Quality Committee each then reviewed the five items before sending it to the ACC Executive Committee for final review and approval.
![Page 57: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/57.jpg)
1. Don't perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.
2. Don't perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.
3. Don't perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery.
4. Don't perform echocardiography as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms.
5. Don't perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (STEMI).
![Page 58: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/58.jpg)
![Page 59: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/59.jpg)
Choosing Wisely Campaign
Keys to Avoid Inappropriate Tests • Choosing Wisely® - Do not perform
testing/procedures in low risk patients who have no documented symptoms or ischemia
• Avoid follow-up testing without change in status, without sufficient time since the last test
![Page 60: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/60.jpg)
• Deficit reduction act of 2005
• More awareness and emphasis on cost & utilization
• Radiology Benefit Mangers (RBMs)
• More data on the need for less serial studies
• Appropriateness use criteria by medical societies, particularly ACC & ACR
Health Affairs, 29:189, 2010
![Page 61: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/61.jpg)
Medical Decision Making
Physician Choice
Patient Choice
Shared Decision Making
![Page 62: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/62.jpg)
![Page 63: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/63.jpg)
Nationwide Campaign to Improve Heart Health
• To encourage patient
involvement and understanding of CV disease
• Evolving to:
– support guideline-based CV care and prevention
– extend the patient-physician relationship
– Shared decision making tools
Cardiosmart.org
![Page 64: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/64.jpg)
2013 - Stormy Waters for Cardiology The Gulf Stream (1899) Winslow Homer
![Page 65: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/65.jpg)
John F. Kennedy in a 1959 campaign speech:
“When written in Chinese the word crisis is composed of two characters. One represents
danger, and the other represents opportunity”
![Page 66: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/66.jpg)
The 2013 Heart Specialist: Quality, Accountability, Transparency & Cost
The Doctor: Sir Luke Fildes, 1887, The Tate Museum, London
![Page 67: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/67.jpg)
The Mission of the ACC
To Transform
Cardiovascular Care and Improve
Heart Health
![Page 68: Dr.Harold_OverviewofAmericanCollegeofCardiology_SJMC Cardiovascular Symposium](https://reader035.fdocuments.in/reader035/viewer/2022081404/5592e5ee1a28ab2d698b4649/html5/thumbnails/68.jpg)