Adoption of care delivery, cost reduction and quality improvement to improve access to care

The American College of Cardiology's Cardiovascular Summit will feature several poster presentations on care delivery, cost reduction and quality improvement that offer innovative concepts to combat access to care, especially during the ongoing COVID-19 pandemic and as the broader health care system works to improve health equity. Research examines the rapid adoption of virtual outpatient care, enabling rural primary care teams to improve cardiovascular health and optimizing emergency room use after clinic hours.

Summaries of embargoed abstracts are below. For access to the full abstracts or to register for media access to the conference, contact Katie Glenn at [email protected].

Rapid adoption of virtual outpatient cardiology care during COVID-19

Following stay-at-home orders in March 2020 in Oregon, a large, integrated cardiology practice with 22 sites moved to implement virtual (telephone and video) platforms while providing patient, provider and staff education. After the stay-at-home order was lifted in June 2020, the institution continued to provide hybrid care to accommodate patients' needs. In a retrospective review of changes from January - October 2020, the institution saw a slight decline in total encounter volumes in March, which recovered in April.

Virtual visits went from 0% prior to March to 98% in April, allowing the institution to mitigate care disruption that would have otherwise occurred. In subsequent months the hybrid model stabilized with more than 30% virtual care after the stay-at-home order lifted. According to the researchers, a hybrid model adoption is a potential long-term option to ensure access and efficiency of cardiology care.

Co-designing an intervention for transformation of cardiovascular care delivery in rural settings

The needs and resources available to rural patients with heart disease are different than their urban and suburban counterparts. A multidisciplinary team in Minnesota developed an intervention to enable rural primary care teams to improve the cardiovascular health of patients with atherosclerotic cardiovascular disease (ASCVD). The team designed an intervention that included adapting existing technology to deliver guideline recommendations to primary care practices and also observed clinical encounters, interviewed patients and conducted workshops with rural care team members to develop feasible intervention concepts.

The collaboration resulted in workflows and a clinical decision support tool that identifies patients with ASCVD who would benefit from additional care touchpoints, aggregates crucial medical information for clinical decision-making and assigns the appropriate care team role to determine care plans. The process developed an intervention that combines novel responsibilities, workflows and technology while recognizing capacities and limitations of rural clinics.

Optimizing emergency room use during after hour triage calls

After hour triage calls at an ambulatory clinic are managed by a telehealth service of Registered Nurses (RN). The RNs follow an accepted protocol for each patient interaction leading to many of these patients being directed to the emergency room, often for an unwarranted visit. However, in an effort to reduce unnecessary utilization of health care resources in response to COVID-19 the clinic sought to improve this process. Starting on April 1, 2020, if the standing protocol suggested a referral to the emergency room, the RN instead connected with the on-call physician or advanced practice provider for further recommendations. The RN would then direct the patient to seek emergency services or an alternative level of care.

The clinic compared calls and referrals from April - October 2019 to April - October 2020 to assess the effectiveness of the new protocol. From April to October 2019, 1,150 patients were referred to the emergency room based on the existing process. From April to October 2020, 332 patients were referred to the emergency room. The new care coordination process reduced emergency room referrals by 55.7% and of those patients 35% were admitted to the hospital. According to the researchers, in addition to better utilizing health care resources, the program showed that of patients sent to the ER by the on-call provider, a higher percentage was admitted, which suggests the clinic was doing a better job of sending the appropriate patients to be evaluated in the emergency room.