Patient education quality improvement interventions increased cardiac rehabilitation referral odds eightfold (OR 8.37, 95% CI 4.32–16.21) in 17,010 patients.
Do quality improvement interventions improve cardiac rehabilitation referral and process outcomes in patients eligible for cardiac rehabilitation?
Quality improvement interventions, particularly patient education, significantly increase cardiac rehabilitation referral rates by over five-fold.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Quality improvement interventions often follow frameworks, including Plan-Do-Study-Act (PDSA), Define, Measure, Analyse, Improve, and Control (DMAIC), Six Sigma, Lean, and audit and feedback, which use iterative cycles and data collection to identify gaps, set goals, and test solutions. Such interventions could enhance adherence to clinical practice standards and reduce variability in quality between cardiac rehabilitation services. However, synthesised evidence of the characteristics and effectiveness of quality improvement interventions within cardiac rehabilitation programs is lacking. Purpose This systematic review and meta-analysis aimed to evaluate the effects of quality improvement interventions on the standard of cardiac rehabilitation processes and patient outcomes. Methods Scopus, Cochrane Central Register of Controlled Trials, Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched from January 2000 to November 2024. The review protocol was prospectively registered in PROSPERO. Included studies (1) implemented a quality improvement framework or stated that a "quality improvement" method was used, (2) were conducted in cardiac rehabilitation settings, and (3) aimed to improve patient and/or program outcomes. Screening was done by two independent reviewers. Meta-analyses used Review Manager v5.3, random-effects model. Data were presented as odds ratio (OR) with 95% confidence interval (CI). Studies not suitable for meta-analysis were reported narratively. Results The search yielded 5,100 studies, of which 15 (76,856 participants) were included. Meta-analysis of 11 studies (17,010 participants) showed that quality improvement interventions significantly improved cardiac rehabilitation processes, primarily referral (OR 5.25; CI 3.11–8.87). Subgroup analyses of specific strategies revealed that patient education had the greatest impact (OR 8.37; CI 4.32–16.21), followed by technology inclusion (OR 5.56; CI 2.67–11.58) and workflow changes (OR 5.31; CI 2.53–11.12), among other strategies (staff education, staffing adjustments, auditing, quality and/or performance indicators, and feedback cycles). Narrative synthesis indicated that quality improvement interventions increased program attendance, completion, adherence to prescription of guideline-directed medical therapy, and shortened wait times. Few studies reported on patient outcomes. Conclusion Quality improvement interventions improve referral to cardiac rehabilitation by up to eight times, with patient education being the most effective. These interventions may also reduce wait times and improve program attendance and completion; however, more evidence is needed to draw firm conclusions. Future studies should further explore patient outcomes.
Kankanamge et al. (Sat,) reported a other. Patient education quality improvement interventions increased cardiac rehabilitation referral odds eightfold (OR 8.37, 95% CI 4.32–16.21) in 17,010 patients.