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Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

Alyeshmerni D, Froehlich JB, Lewin J, Eagle KA - Rambam Maimonides Med J (2014)

Bottom Line: As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost.Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies.These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Diseases, University of Michigan Health System, Ann Arbor, MI, USA; and.

ABSTRACT
Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

No MeSH data available.


Related in: MedlinePlus

Percentage of Patients Exceeding the Maximum Weight and Creatinine-adjusted Contrast Dose, and Percentage of Patients Developing Nephropathy Requiring Dialysis.From Figure 2 of Moscucci et al.,26 with permission.
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f7-rmmj-5-3-e0017: Percentage of Patients Exceeding the Maximum Weight and Creatinine-adjusted Contrast Dose, and Percentage of Patients Developing Nephropathy Requiring Dialysis.From Figure 2 of Moscucci et al.,26 with permission.

Mentions: A similar approach is taken at a larger scale in The Blue Cross Blue Shield of Michigan Cardiovascular Collaborative (BMC2) quality improvement collaborative.23,24 In this program, all process and outcome measures of the state’s coronary interventions are documented and entered in a central core laboratory that produces regular reports for operators and hospitals. Through their efforts, the BMC2 investigators identified a maximum allowable contrast dose for patients undergoing an angioplasty that predicted a 6-fold risk increase in the development of acute renal failure.25 By implementing a strategy where the maximum allowable contrast dose was calculated before a patient underwent angioplasty in each hospital, the investigators were able to achieve a significant reduction in the frequency of dialysis-dependent renal failure after coronary intervention (Figure 7).26 This is an example of the detection and prevention of a relatively infrequent but severe complication related to care processes that would have gone undetected without a large collaborative study. This model in Michigan can be readily duplicated by other states, and the Affordable Care Act is likely to lead to similar large regional and national consortia for improving care and preventing harm.


Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

Alyeshmerni D, Froehlich JB, Lewin J, Eagle KA - Rambam Maimonides Med J (2014)

Percentage of Patients Exceeding the Maximum Weight and Creatinine-adjusted Contrast Dose, and Percentage of Patients Developing Nephropathy Requiring Dialysis.From Figure 2 of Moscucci et al.,26 with permission.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4128588&req=5

f7-rmmj-5-3-e0017: Percentage of Patients Exceeding the Maximum Weight and Creatinine-adjusted Contrast Dose, and Percentage of Patients Developing Nephropathy Requiring Dialysis.From Figure 2 of Moscucci et al.,26 with permission.
Mentions: A similar approach is taken at a larger scale in The Blue Cross Blue Shield of Michigan Cardiovascular Collaborative (BMC2) quality improvement collaborative.23,24 In this program, all process and outcome measures of the state’s coronary interventions are documented and entered in a central core laboratory that produces regular reports for operators and hospitals. Through their efforts, the BMC2 investigators identified a maximum allowable contrast dose for patients undergoing an angioplasty that predicted a 6-fold risk increase in the development of acute renal failure.25 By implementing a strategy where the maximum allowable contrast dose was calculated before a patient underwent angioplasty in each hospital, the investigators were able to achieve a significant reduction in the frequency of dialysis-dependent renal failure after coronary intervention (Figure 7).26 This is an example of the detection and prevention of a relatively infrequent but severe complication related to care processes that would have gone undetected without a large collaborative study. This model in Michigan can be readily duplicated by other states, and the Affordable Care Act is likely to lead to similar large regional and national consortia for improving care and preventing harm.

Bottom Line: As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost.Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies.These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Diseases, University of Michigan Health System, Ann Arbor, MI, USA; and.

ABSTRACT
Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

No MeSH data available.


Related in: MedlinePlus