Focus on Cardiovascular Disease

Conclusion

Quality Profiles: The Leadership Series is offered to health care organizations with the sincere hope that it will empower them to assume a leadership role in moving the care continuum toward primary prevention. It is time for new ideas to emerge on how to improve the quality of health care, building on the principles of performance measurement and transparency promoted by the Health Plan Employer Data and Information Set (HEDIS®). Health care organizations must think “out of the box” to come up with novel, technologically advanced ways to organize services and design care processes around patient needs, encourage clinician collaboration, and reward quality care. Practical tools - like Quality Profiles: The Leadership Series - can support the successful planning and development of initiatives that assess the impact of these advancements on the quality of care, facilitating the fine-tuning of health care systems and processes.

In this issue of Quality Profiles: The Leadership Series, we have examined quality improvement in the area of cardiovascular disease (CVD). To be effective in the primary and secondary prevention of CVD, health care organizations should be aware of the concept of overall cardiovascular risk, which takes into account the combined impact of multiple cardiovascular risk factors.[1] This concept is based on findings from the Framingham Heart Study, which brought to light the clustering of cardiovascular risk factors,[2] the multiplicative impact of multiple risk factors,2,3 and the substantial risk imparted by even mild-to-moderate levels of multiple risk factors.[4]

Although the quality of cardiovascular care has been steadily improving, there is still a gap between how cardiovascular care is generally practiced and how it should be practiced, particularly for patients with multiple risk factors. The more risk factors a patient has, the less likely it is that all of the risk factors will be in control.5 In their role as managers of health care for millions of Americans, health plans can use their expertise and resources to conduct quality improvement (QI) initiatives that will improve the health care management of patients with multiple cardiovascular risk factors.

The quality improvement activities (QIAs) profiled in this installment of Quality Profiles: The Leadership Series have shown that health plans are, in fact, conducting QI initiatives aimed at improving the management of not only individual risk factors for CVD, but multiple risk factors as well. These QIAs taught the plans that:

• Early consensus on optimal management of risk factors is critical to the success of the QIA
• Disease management programs are effective in improving the quality of care
• Patient and physician resistance to disease management programs can be overcome
• Patients should be reassured that disease management programs will not interfere with the patient-doctor relationship
• Reimbursement for quality care can help to motivate practitioners to improve their quality of care
• Physician cooperation can be achieved by using pilot programs to investigate root cause issues, best interventions, and needed processes before the disease management program is rolled out

Even though each organization has its own unique barriers, member and clinician needs, and resource issues, these insights can be helpful. By learning from the examples of the model QIA initiatives we have presented - and adapting or fine-tuning them to fit their own unique needs - health care organizations can move their CVD management programs along the quality continuum toward optimal patient-centered care - the modification and control of multiple cardiovascular risk factors both before and after CVD has developed.

If health care organizations continue to shift the focus of care toward prevention of CVD, patient quality of life will improve and lives will be saved.

[1] - Poulter N. Global risk of cardiovascular disease. Heart. 2003;89(suppl II):ii2-ii5.

[2] - Poulter N. Coronary heart disease is a multifactorial disease. Am J Hypertens. 1999;12:92S-95S.

[3] - Kannel WB. Contribution of the Framingham study to preventive cardiology. J Am Coll Cardiol. 1990;15:206-211.

[4] - American Heart Association updates heart attack, stroke prevention guidelines [press release]. July 15, 2002. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3003675. Accessed July 24, 2003.