School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada (Ms Somanader and Dr Grace), GoodLife Fitness Cardiovascular Rehabilitation Unit, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada (Drs Chessex and Grace), School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada (Dr Ginsburg).
J Cardiopulm Rehabil Prev. 2017 Nov;37(6):412-420. doi: 10.1097/HCR.0000000000000223.
Cardiac care, including cardiovascular rehabilitation (CR), is most effective if it is high-quality. The aim of this study was to describe CR quality, using the recently developed Canadian Cardiovascular Society CR quality indicators (QIs). Difference in quality between CR sites was also assessed.
Secondary analysis was conducted on an observational, prospective, multisite CR program evaluation cohort. A convenience sample of patients from 1 of 3 CR programs was approached at their first CR visit, and consenting participants completed a survey. Clinical data were extracted from charts pre- and postprogram. Of the 30 CR QIs, 21 (70.0%) were assessable: 10 process, 9 outcome, and 2 structure QIs.
Of 411 consenting patients, 209 (53.0%) completed CR. The greatest quality was observed for assessment of blood pressure (98.1%), communication with primary health care at CR discharge (94.2%), and patient enrollment (94.0%). The lowest quality was observed for wait time from hospital discharge (9.2%), assessments of blood glucose (42.1%), and lipid control (53.0%). Of the 7 QIs that had an established benchmark, quality for 2 (28.6%) was above the benchmark (particularly assessment of blood pressure). Significant between-site differences were observed in 11 (64.7%) QIs. The magnitude of quality differences between sites was largest for assessment of lipid control (72.6%), assessment of blood glucose control (69.0%), and wait time in median days from referral to enrollment (30.6 days).
There is wide variability in CR program quality, both overall and between CR sites. Quality improvement in particular aspects of CR care is required.
如果心脏护理（包括心血管康复（CR））质量高，则效果最佳。本研究的目的是使用最近开发的加拿大心血管学会 CR 质量指标（QIs）来描述 CR 质量。还评估了 CR 地点之间的质量差异。
对观察性、前瞻性、多地点 CR 计划评估队列进行了二次分析。从 3 个 CR 计划中的 1 个计划中抽取了方便的患者样本，在他们的首次 CR 就诊时与他们接触，并获得了同意的参与者完成了一项调查。临床数据从计划前后的图表中提取。在 30 个 CR QIs 中，有 21 个（70.0％）是可评估的：10 个过程，9 个结果和 2 个结构 QIs。
在 411 名同意的患者中，有 209 名（53.0％）完成了 CR。观察到最大的质量是评估血压（98.1％），CR 出院时与初级保健沟通（94.2％）以及患者入组（94.0％）。观察到最低的质量是从医院出院后的等待时间（9.2％），血糖（42.1％）和血脂控制（53.0％）评估。在 7 个具有既定基准的 QIs 中，有 2 个（28.6％）的质量超过了基准（特别是血压评估）。在 11 个（64.7％）QIs 中观察到站点之间存在显著差异。站点之间的质量差异最大的是血脂控制评估（72.6％），血糖控制评估（69.0％）和从转诊到入组的中位数天数（30.6 天）的等待时间。
CR 计划质量存在很大差异，无论是整体质量还是 CR 地点之间的质量。需要改善 CR 护理的某些方面的质量。
