This post comes from ACC immediate past President James Dove, M.D., M.A.C.C. Dr. Dove is a clinical professor of medicine, Division of Cardiology, at Southern Illinois University, and a founding partner of Prairie Cardiovascular Consultants, Ltd., a 42-member group of cardiologists. As president, Dr. Dove set in motion ACC's efforts in implement quality in cardiovascular care.
For 25 years, the American College of Cardiology Foundation and the American
Heart Association have produced clinical practice guidelines. These guidelines carefully review the
available evidence, rank the importance and significance of major trials and
the voluminous medical literature. The results are lengthy guidelines with a
series of recommendations, classified as I, IIa, IIb, and III, depending on the
strength of the recommendations.
The documents are a wonderful
distillation of the literature and serve as a tremendous resource guide to
practitioners. They are, however,
difficult to apply at the bedside.
Numerous attempts have been made by the College to help address that
difficulty. Wall charts, pocket guides
and other tools have been produced in an effort to facilitate clinical
application. These processes, while
helpful, have failed in the application of the Class I guideline recommendations
100% of the time in every patient in whom the recommendations are appropriate.
Best practices in the future
will use computer decision-support tools (CDS) that function well within the
clinical workflow and facilitate decision-making as well as providing reminders
at the point of care. These tools can
also automatically collect process measures without requiring additional time-consuming
chart reviews. Computer decision-support
tools will allow us to apply the guidelines every time to every patient for
whom the guideline is appropriate and to document clearly the reasons a
specific recommendation is not appropriate for a given patient.
The time is now to adopt and
develop these computer decision-support tools to function at the point of care,
document quality and facilitate our adherence to best medical practices.
This is not cookbook medicine
– instead, it allows us for the first time to effectively collect data about
adherence to guidelines, appropriate deviations from guidelines, and eventual
correlation of process measures and the effects of those measures on clinical
outcomes. There is no better way to
document the significance of process measures of all classification levels than
to do so at the point of care and correlate that information with clinical
outcome in thousands of patients.
- By James Dove, M.D., M.A.C.C., ACC immediate past president
* Dr. Dove's post is the fourth in a new monthly series of guest
posts by ACC leadership. Check back next month to see which ACC leader
is sharing his or her thoughts on health care reform!