ACPM Resolutions Introduced at Preventive Medicine 2003
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1. Patient Safety
2. Abolition of Symptomatic Coronary Heart Disease

Resolution 01-03 

RESOLVED that the American College of Preventive Medicine (ACPM) demonstrate leadership in the area of patient safety by supporting and working with the Institute of Medicine, Agency for Healthcare Research and Quality, the National Patient Safety Foundation, the American Medical Association, Veterans Health Administration, the Quality Interagency Coordination Task Force, the National Quality Forum, the Forum for Leadership in the Specialty of Preventive Medicine, and other entities committed to improving patient safety.

RESOLVED that the ACPM work, in partnership with other organizations, to increase public and professional understanding of patient safety as a public health problem that can and should be effectively addressed.

RESOLVED that the ACPM encourage preventive medicine residency programs develop the educational interventions and approaches that prepare their graduates to be leaders in improving patient safety.

RESOLVED that the ACPM support research in patient safety, specific to clinical preventive services, to reduce medical errors.

RESOLVED that the ACPM encourage the American Journal of Preventive Medicine and other preventive medicine journals to increase their content related to patient safety, thereby increasing knowledge and stimulating additional research.

RESOLVED that the ACPM invite qualified members to serve where appropriate on workgroups, coalitions, and committees to advance patient safety research, interventions, policies, and legislation that are consistent with its mission and objectives.

RESOLVED that the ACPM support policies and legislation that address patient safety through effective and efficient approaches.

ACPM adopted the proposed resolution with the following amendments:

• Amend the 4^th Resolve to read: THAT: The ACPM, in collaboration with others, work to enhance the evidence base in patient safety, both specific to clinical preventive services, and as part of the population-based approach to balance the benefits and risks of interventions.

• Add "evidence-based" to the 7^th Resolve.

• Add an 8^th Resolve: THAT: The ACPM encourage the Task Force on Community Preventive Services to review the effectiveness of health care system interventions that assure patient safety and to make recommendations for their use and for additional research.

Dr. Kohatsu presented the resolution at the ACPM Open Policy Forum and to the Policy Committee. Forum participants and committee members were unanimous in their support of the resolution. A suggestion was made to enhance the fourth Resolve to ensure that ACPM would work in partnership with other organizations to advance the research of medical errors and how to prevent them. There was some debate about whether or not the resolution should also address errors of omission. It was agreed that the Resolve should address research of population-based approaches that seek to balance the benefits and risks of interventions. Similarly, the committee agreed to add a Resolve calling on the Task Force on Community Preventive Services to review the effectiveness of population- or system-based approaches.

Resolution 02-03 

RESOLVED that the ACPM should recommend the absolute prevention (abolition) of symptomatic coronary artery disease as has been documented in the peer-reviewed, population-based studies.

RESOLVED that the ACPM form a Coronary Artery Disease Task Force to do the following on behalf of ACPM:

1. Petition NCEP to address the abolition of symptomatic Coronary Artery Disease in their upcoming recommendations (anticipated release, December 2003)
2. Petition U.S. Preventive Services Task Force to address this issue.
3. Petition both the CDC and NIH to increase research, programming and funding directed toward the abolition of symptomatic coronary artery disease
4. On a continuing basis, advise the ACPM Policy Committee and Board of new research findings and policy recommendations relative to the abolition of symptomatic coronary artery disease.
5. Submit articles to the ACPM print and electronic newsletters to educate ACPM members as to the feasibility of accomplishing the abolition of symptomatic coronary heart disease, and the means by which this can be done.

The Policy Committee recommended, and the Board of Regents approved, that the resolution be referred to the ACPM Prevention Practice Committee for further review of the science on which the recommendations are based.

Dr. Joel Nitzkin presented the resolution at the Open Policy Forum on behalf of the author, who was not able to attend the ACPM annual meeting. There seemed to be consensus both at the Forum and among Policy Committee members that the overall evidence base was too small to support the recommendation espoused in the 1^st Resolve. Most individuals who testified felt that recommending "abolition" of symptomatic coronary artery disease was beyond what the current evidence would support and that perhaps we should focus instead on making dramatic reductions in disease rates. Concern was also raised that this resolution focuses on only one risk factor for heart disease and that we should think more broadly.

It was noted that the recommended extreme diet regimen clearly could work for some individuals, but that the effects of implementing such a regimen on the population at large were still unknown. It was suggested that we still don’t know the ratio of risk to benefits of this diet and that if the USPSTF analyzed the evidence for this intervention, it would find "insufficient evidence" to make a recommendation for the population. It was suggested that ACPM be consistent with its current diet recommendations, as recently adopted in the ACPM position statement on weight management and prevention of obesity, type 2 diabetes, and insulin resistance.

There was support for the overall theme of the recommendations in the 2^nd Resolve calling for additional analysis of the evidence and identification and funding of research needs.

For more information, contact Mike Barry.