The ABCS Metrics the evidence, the conversation, and the decision LJ Fagnan, MD, and the H2N team April 27, 2016 This project is supported by grant number R18HS from the Agency for Healthcare Research & Quality.

2 Maximize Your Webinar Experience 1.If you have any trouble connecting or hearing us, see your invitation for troubleshooting WebEx. We are recording all webinars, and you can find them at: All participants are muted on entry. During the webinar participants are encouraged to ask questions via the WebEx chat function. Direct questions to the panelists. At the end of the presentation we will unmute all lines to allow time for verbal questions. 3.We’ll be asking for your feedback in a short question survey once the webinar is finished. That’s also another chance to ask us questions if you would like.

3 Speaking Today Emily Chirnside PERC, Oregon Rural Practice-based Research Network LJ Fagnan Director, Oregon Rural Practice-based Research Network Beth Sommers PERC, Oregon Rural Practice-based Research Network

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5 Stories From the Field Emily Chirnside Portland-Metro & Columbia Gorge PERC Beth Sommers Portland-Metro PERC

6 ABCS Measures Why—to improve cardiovascular health of individual patients and populations How—using evidence- based guidelines and patient-centered communication What—evidence-based decisions aligned with patient preferences and values

7 The Why

8 ABCS Impact on Health Kottke, T.E. (2016, March, 4). The Public Health Stakes Of Evidencenow And Escalates Participation: A Researcher’s Perspective [Web log post]. Retrieved from escalates-participation-a-researchers-perspective-2/

9 The How Million Hearts Targets: Optimizing Care in the Clinical Setting “The 70% values…are clinical targets for people engaged in the health care system.” “An estimated 46,000 deaths could be avoided annually if 70% of patients with high blood pressure were treated according to published guidelines”

10 ABCS Measure Benchmarks and Performance Rates Source of Data Aspirin NQF 0068 CMS164 Blood Pressure Control NQF 0018 CMS165 Statin Therapy (Cholesterol) NQF in progress CMS347 Smoking Screening and Cessation NQF 0028 CMS138 Million Hearts Initiative – National Baseline54%52%43%Not available Million Hearts Initiative – Clinical Targets for % AHRQ EvidenceNOW Clinical Targets80% HRSA UDS – Oregon (2014)80%64%Data not available84% PQRS Registry – Oregon (2014)85%73%Data not available92% YOUR Practice?

11 Evidence–based Medicine: What it is and what it isn’t. Evidence-based medicine is not cookbook medicine It requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patient choice. ( Sackett DL. BMJ Editorial )

12 The What Patient Preferences – medical decisions necessarily involve value judgements

13 Invite the Patient to Participate “There’s a decision to make about your treatment (or testing) and I’d like to make it with you. Knowing what’s important to you will help us make a better decision.” OR “Sometimes things in medicine aren’t as clear as most people think. Let’s work together so we can come up with the decision that’s right for you.”

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16 What are the benefits and harms of aspirin therapy (over 10 years)? Shareddecisions.mayoclinic.org/files/2011/08/Aspirin_DA_high.pdf

17 Available Decision Aids Mayo Clinic SDM Resource Center Healthwise aspx?DOCHWID=uf aspx?DOCHWID=uf9825

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20 Shared Decision Making Healthwise SDM Decision Aid: ochranedecisionaid/Content /StdDocument.aspx?DOCH WID=zx ochranedecisionaid/Content /StdDocument.aspx?DOCH WID=zx1768 Simmons, Sepucha. SGIM Forum 2014; 37(6)

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23 (Weymiller et al. Arch Intern Med 2007) Statin Choice

24 Available Decision Aids o Mayo Clinic SDM National Resource Center. o Healthwise, “Statins: Should I Take Them to Prevent a Heart Attack or Stroke”, t/StdDocument.aspx?DOCHWID=aa t/StdDocument.aspx?DOCHWID=aa44406 o National Institute for Health and Care Excellence (NICE). Taking a statin to reduce CHD. Patient Decision Aid, t-decision-aid t-decision-aid

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28 Tobacco Cessation Decision Aids o Healthwise, “Quitting Smoking: Should I Use Medicine”: /Content/StdDocument.aspx?DOCHWID=zw /Content/StdDocument.aspx?DOCHWID=zw11 24 o USPSTF.Behavioral and Pharmacotherapy Interventions for Tobacco Cessation. Ann Int. Med.20October2015. A recommendation

29 Coming Attractions May 11 th Office Hours May 25 th Office Hours June 22 nd Webinar Future Webinars and Office Hour topics will be based on what we hear from you and your coaches. And don’t forget, you can go to to catch up on what you have missed!

30 Questions?

31 What strategies have you used to share/promote the ABCS metrics? Clinical guidelines State/County/Local cardiovascular disease reports EvidenceNOW one-pagers Presenting at staff and/or clinician meetings Expert talk One-on-one conversations