Assns.' report aims to foster better shared decision-making

What patients do and don't do should be considered in programs designed to improve care and patient outcomes, according to a report from the American College of Cardiology (ACC), American Heart Association (AHA), American Association of Cardiovascular and Pulmonary Rehabilitation, American Academy of Family Physicians and the American Nurses Association in collaboration with other professional organizations.

Clinicians have numerous performance measures to meet, such as making sure aspirin is given within the first 24 hours of the arrival of a patient having a heart attack to the hospital. But, the organizations say that incorporating both clinicians and patients into shared-accountability performance measures may be an important way to improve patient-centered outcomes, morbidity and mortality.

The report, “The Concepts for Clinician–Patient Shared Accountability in Performance Measures,” was developed in collaboration with the National Committee for Quality Assurance, the American Society of Health System Pharmacists and the American Medical Association–convened Physician Consortium for Performance Improvement. It is endorsed by the American Society of Health-System Pharmacists.

Traditionally, performance measures have been clinician focused but their success is heavily dependent on patient actions. Recognizing this, the developing organizations sought to outline the key concepts, measurements and considerations for implementing patient-clinician shared-accountability performance measures.

In order to implement shared-accountability performance measures, patients must have “sufficient support and knowledge to actively participate in their healthcare,” the report says. Shared goal setting, shared decision making and shared care planning and monitoring between patient and clinician are all important concepts to implement as part of shared-accountability performance measures, the report said.

Further, measures should be shifted from assessing acute care processes to longitudinal outcomes, according to the report. For example, medication adherence should be tracked instead of only drug prescription and whether treatments achieved their goal should also be evaluated.

“Current performance measures often just focus on whether a medication is prescribed or not, but these medications are often used to treat chronic conditions, like hypertension, and need to be taken lifelong or for extended periods of time,” said P. Michael Ho, MD, PhD, staff cardiologist at the Veterans Affairs Eastern Colorado Health Care System and writing committee co-chair, in a release. “Achieving this longitudinal adherence is a shared responsibility, as the clinician must discuss treatment preferences and provide proper education, while the patient must follow the regimen and communicate any adverse effects. By properly acknowledging and motivating these interrelated factors, shared-accountability performance measures can help improve longitudinal treatment adherence, which a growing body of evidence has shown is quite poor.”

The report further discusses methodological challenges involved with shared-accountability performance measures. These include how to measure patient adherence, where to incorporate patients who refuse treatments and how to specify episodes of care for longitudinal measures.

The paper was published on the websites for the ACC (www.cardiosource.org) and AHA (www.heart.org) and will be published in an upcoming print edition of the Journal of the American College of Cardiology.