Infographic courtesy of ESCALATES (www.escalates.org)

ABCS saves lives: 4 steps to help you use the metrics in your practice

By LJ Fagnan, MD, Director of the Oregon Rural Practice-based Research Network (ORPRN) A recent study shows that primary care practices that focus on improving their patients’ ABCS measures are at least 81 percent more effective at preventing deaths due to cardiac-related conditions than cardiologists focusing on outcomes for hospitalized patients. These measures target better care for patients’ heart health using metrics for Aspirin, Blood pressure, Cholesterol, and Smoking Cessation. Here are four practical ways to work the ABCS into your clinic’s day-to-day care. 1. Understand your impact One of the incredible findings that recently came to light was the impact the ABCS measures have on health. Much of the greatest benefit derives from the fact that, unlike hospital interventions, treating these risk factors prevents multiple diseases. Research from the Agency for Healthcare Research and Quality-funded ESCALATES project tells us that there’s a lot that you can do in the office to provide better heart health care. But how exactly do we go from research to practice? Nobody argues that these metrics are appropriate and they have evidence behind them, but busy primary care providers don’t have a lot of time to review research studies. We know providers need to feel that they’re up to date. 2. Initiate a conversation with your patients Primary care physicians and their practice team staff can use evidence from research to open up a conversation with patients so that they can work to make decisions around reducing the risks of a cardiovascular event. Practice physicians can work to coordinate their clinic’s use of the ABCS measures so that if a patient sees a different doc or another member of the team, the message that patients are getting will be consistent. You can display patient education materials on the ABCS measure in your clinic. 3. Understand your patients’ values and preferences A conversation with a patient might go something like this: “Here’s what we know about your situation, what do you think about trying to get your blood pressure under control so we can reduce your risk of a heart attack?” We can tell patients to do something, but without understanding how they feel about it and how they view a recommendation in terms of how they approach their health care, we may be missing an opportunity to engage them. It can be completely ineffective, too. A lot of patients leave the office with a prescription for blood pressure medication or statins, and don’t get it filled. This conversation is important because we have an obligation to listen and understand where patients are in the decision-making process. 4. Get your whole practice on board and involved In our Healthy Hearts Northwest project, we’re seeing that the docs who are the most effective are the ones who share their knowledge. When we talk about sharing the evidence, it’s not just with your patients but with your entire clinic (practice managers, MAs, etc.). We’ve been noticing in some clinics that the larger care team becomes empowered with this information. For some staff, it’s the first time they’ve really understood what evidence-based medicine is and how to put it into practice. They’re excited and motivated. Clinics are posting the ABCS measures on their walls and in their break rooms. Although my comments here focus on new evidence around ABCS metrics, implementing any evidence can go beyond the clinician. Docs are realizing that they can’t go it alone in clinic. The physicians that are the most effective are the ones who distribute this knowledge, and also distribute the responsibility for having patient conversations about evidence-based medicine throughout the entire team. To learn more, visit the Healthy Hearts Northwest events page and view the slides from our April webinar: “The ABCS Metrics: the evidence, the conversation, and the decision.” Dr. Fagnan is Director of the Oregon Rural Practice-based Research Network (ORPRN). He practiced rural family medicine in Bethel, Alaska and Reedsport, Oregon before joining the Department of Family Medicine faculty at Oregon Health & Sciences University. He is also a scientific investigator for the Healthy Hearts Northwest project.

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