Key result
ICCPR Program Certification proves feasible as 100% of low-resource pilot programs meet core quality standards.
Why the study?
Cardiac rehabilitation is a proven secondary prevention model, but new sites providing quality care are needed in low-resource settings, prompting the development and evaluation of an international program certification.
The ICCPR Program Certification is a feasible, rigorous, and acceptable quality assurance framework for cardiac rehabilitation programs operating in low-resource settings.
Answers are grounded in this paper and cite their sources.
Supports ICCPR certification feasibility in low-resource CR; leaves open impact on outcomes and need for larger trials.
Background: Cardiac rehabilitation (CR) is a proven model of secondary prevention, but new sites, providing quality care, are needed in low-resource settings. This study (1) described the development of International Council of Cardiovascular Prevention and Rehabilitation's (ICCPR) Program Certification and (2a) tested its implementation, considering (b) appropriateness of quality standards for these settings. Methods: The Steering Committee finalized 13 standards, requiring 70% be met. They are assessed initially through International CR Registry (ICRR) program survey and patient data; if Certification appears possible, a two-hour virtual site assessment is arranged to corroborate. Standard operating procedures for Assessor training were developed. A multi-method pilot study was then undertaken with a quantitative (description of quality indicators) and qualitative (focus groups on MS Teams) component. ICRR sites with post-program data by April 2022 were invited to participate. Two team members independently analyzed focus group transcripts, using a deductive-thematic approach with NVIVO. Results: Five CR programs from the Eastern Mediterranean, South-East Asian and American regions participated. Upon application, with some data cleaning, initially four programs were eligible to proceed to virtual site assessment. Ultimately, all five programs were certified, each meeting a minimum of 12/13 standards (peak MET increase and program completion rate were not met by some centres). Four themes resulted from the two focus groups of 13 site data stewards: motivation and benefits (eg, international recognition, additional program resources), logistics (eg, communication, cost, site visit process), the standards and their assessment (eg, balance of rigor and feasibility), and suggestions for improvement (eg, website). Conclusion: ICCPR's Program Certification has been demonstrated to be feasible, rigorous, and acceptable. Standards are attainable in low-resource settings. Certified programs reap benefits including additional resources. This first international Certification is suitable for low-resource settings, to complement that from the American and European CR Societies.
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Turk-Adawi et al. (2023) studied Cardiovascular disease (cardiac rehabilitation) (n=5). ICCPR Program Certification was evaluated on Program certification success (meeting ≥70% of 13 quality standards). The ICCPR Program Certification was demonstrated to be feasible and rigorous, with all 5 pilot cardiac rehabilitation programs in low-resource settings successfully meeting at least 12 of 13 quality standards.
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