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:
- The denominator for each indicator is the number of patients in the program over a given time period
- All indicators below describe the numerator, and hsould be expressed as a percentage of the denominator
||% of eligible patients:
|Access and utilisation of services
- Referred to an appropriate rehabilitation or support program
- Followed up of referral within a specified time period and patient contacted
- Completing a programmed intervention
- Physically active for 30 minutes daily or adhere to a recommended level of exercise
- Smokers who stop smoking
- With a personalised exercise program
- Assessed on a standardised instrument of exercise capacity (such as the 6-minute walk test)
- Prescribed appropriate medications at hospital discharge/at clinical reviews‡
- Medications titrated to maximal tolerated doses‡
- Screened for depression†
- Assessed on a quality of life measure†
|Self-care and education
- Assessed for relevant lifestyle risk factors (e.g., smoking, poor nutrition, salt intake, alcohol intake, physical inactivity, unhealthy body weight)
- With a personalised written action plan
|Additional assessment as required
|Health outcomes at specified time periods (1 to 12 months)
- Deaths within X days of hospital discharge (cardiac and non-cardiac causes)
- X-day re-admission rates (all cause, cardiac-specific, heart failure related)
- Change in quality of life over X months measured on a validated tool (5% difference in some measures is clinically significant)
- Change in NYHA class over X months (HF only)
- Change in ability to self-manage chronic disease measured on a validated tool
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.