Improvement measures that focus on primary and secondary prevention of coronary artery disease and hypertension in the ambulatory setting. Application of these performance measures will provide a mechanism through which the quality of medical care can be measured and improved

• The 10 measures were characterized as groundbreaking by the committee that wrote the guidelines, not only because they are the first to focus on outpatient care, but because they also go beyond just treatment recommendations to asking health care providers to control target goals.
• Patients are also urged to play a big role in improving the quality of their own care.
• According to the measures, patients are expected to keep appointments, modify their lifestyle, and adhere to medication regimens.
• In patients with coronary artery disease the new measure requires blood pressure control, and gives the parameters for that control.
• Similarly, for lipids, the guideline has evolved from measuring and providing medications, to also reporting on control of the condition.
• In the past, symptoms and activity were evaluated separately, sometimes giving a false view of angina.
• Practitioners are now asked to assess the two simultaneously.
• The measures also still urge tobacco use screening, and cessation and intervention, and contain guidelines on prescribing and monitoring beta-blocker, antiplatelet, and ACE inhibitor therapy.
• For hypertension, the new guidelines combined two measures on blood pressure measurement, and coming up with a plan of care, into one measure that tracks the control of blood pressure.
• There are two new measures
1. The first puts an emphasis on symptom management. It requires physicians to track the percentage of patients 18 or older with a diagnosis of coronary artery disease seen within a 12-month period, reporting on activity evaluation – evaluation of the presence or absence of anginal symptoms with appropriate management of those symptoms. If there are symptoms, physicians should document a plan of care to control them.
2. A second measure calls on physicians to refer all patients who’ve had an acute myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, cardiac valve surgery, or cardiac transplantation, or who have chronic stable angina to a rehabilitation or secondary prevention program.
• The committee found that rehabilitation programs are severely underused and aims to use the measure to highlight the gap in care.
• Although prescribing physicians have some influence on patient choices, adherence is largely not in the individual physician’s locus of control.” The committee envisioned that if such a measure existed, physicians might avoid caring for patients who were nonadherent.
• Several other measures, including one that would have looked at overuse of stress testing and others on appropriate use of percutaneous coronary intervention were rejected.

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