February 2, 2019
View Full PaperCardiac Rehabilitation Quality Improvement
Key Result
A review of 27 cardiac rehabilitation quality indicators revealed high performance in physical activity promotion but gaps in stress management, smoking cessation, and blood glucose assessment.
Structured PICO
P
Population
Cardiac rehabilitation programs internationally
E
Exposure
Quality indicators and quality improvement strategies
O
Outcome
Evaluation of CR quality indicators, summary of CR quality, and recommendations for improvement
This review identifies gaps in cardiac rehabilitation quality internationally and recommends strategies for quality improvement, noting that audit and feedback alone are insufficient.
Limitations
- Not a lot is known about cardiac rehabilitation quality
- The quality improvement initiatives recommended require testing to ascertain whether quality can be improved
Abstract
PURPOSE: Despite evidence of the effectiveness of cardiac rehabilitation (CR), there is wide variability in programs, which may impact their quality. The objectives of this review were to (1) evaluate the ways in which we measure CR quality internationally; (2) summarize what we know about CR quality and quality improvement; and (3) recommend potential ways to improve quality. METHODS: For this narrative review, the literature was searched for CR quality indicators (QIs) available internationally and experts were also consulted. For the second objective, literature on CR quality was reviewed and data on available QIs were obtained from the Canadian Cardiac Rehabilitation Registry (CCRR). For the last objective, literature on health care quality improvement strategies that might apply in CR settings was reviewed. RESULTS: CR QIs have been developed by American, Canadian, European, Australian, and Japanese CR associations. CR quality has only been audited across the United Kingdom, the Netherlands, and Canada. Twenty-seven QIs are assessed in the CCRR. CR quality was high for the following indicators: promoting physical activity post-program, assessing blood pressure, and communicating with primary care. Areas of low quality included provision of stress management, smoking cessation, incorporating the recommended elements in discharge summaries, and assessment of blood glucose. Recommended approaches to improve quality include patient and provider education, reminder systems, organizational change, and advocacy for improved CR reimbursement. An audit and feedback strategy alone is not successful. CONCLUSIONS: Although not a lot is known about CR quality, gaps were identified. The quality improvement initiatives recommended herein require testing to ascertain whether quality can be improved.