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Effectiveness can be evaluated for both internal quality improvement purposes and external comparison 'benchmarking':
Overall program effectiveness is determined by aggregating various levels of service provision and delivery. Indicators measure different domains such as: health outcomes (mortality and readmission); patient report outcomes and quality of life; and clinical processes (adherence to the latest clinical guidelines).
Selecting an assortment of measures across several domains will provide sufficient data for evaluating the effectiveness of the program in delivering each component of care, as well as assessing overall program effectiveness.
The table below shows some examples of indicators suitable for cardiac rehabilitation (CR) or heart failure (HF) disease management programs. Please check major guidelines for your region for suggested indicators (see references below).
In terms of calculating each indicator:
Indicators | % of eligible patients: |
---|---|
Access and utilisation of services |
|
Behavioural |
|
Exercise |
|
Medications |
|
Psychosocial |
|
Self-care and education |
|
Additional assessment as required |
|
Health outcomes at specified time periods (1 to 12 months) |
|
Key: † Assess using an appropriate instrument that is reliable and validated for clinical group, where available; ‡ Except where contraindicated or not tolerated.
Table: Examples of measures of cardiac rehabilitation and heart failure programs
Indicators specific for heart failure and cardiac rehabilitation are found in recent guidelines [#atherton-jj-sindone-a-de-pasquale-cg-et-al, #bonow-ro-ganiats-tg-beam-ct-et-al.-2012, #gallagher-r-thomas-e-astley-c-et-al.-cardiac-rehabilitation-quality-in-aust, #thomas-rj-balady-g-banka-g-et-al, #the-bacpr-standards-and-core-components-for-cardiovascular-disease-preventi]
Tip: Always collect patient demographic and psychosocial characteristic data, such as disease severity, clinical status, age and treatment setting. This is crucial if you wish to later attribute any differences in program outcomes to quality of care, rather than to the underlying difference in patient characteristics or program setting.
Performance evaluation has no ‘one size fits all’ guide. The level of evaluation depends on many factors and should be designed to suit the program, preferably using a combination of qualitative and quantitative methods.
Data collection tips:
When interpreting results, consider:
Atherton JJ, Sindone A, De Pasquale CG, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018. Med J Aust. 2018
Bonow RO, Ganiats TG, Beam CT, et al. ACCF/AHA/AMA-PCPI Heart failure performance measures. J Am Coll Cardiol 2012;59:1812-1832.
Gallagher R, Thomas E, Astley C, et al. Cardiac Rehabilitation Quality in Australia: Proposed National Indicators for Field-Testing [published online ahead of print, 2020 Apr 30]. Heart Lung Circ. 2020;S1443-9506(20)30109-8. doi:10.1016/j.hlc.2020.02.014
Thomas RJ, Balady G, Banka G, et al. 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. 2018;71(16):1814-37.