School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada (Ms Moghei and Dr Grace); and Cardiovascular Prevention and Rehabilitation Program, University Health Network, University of Toronto, Ontario, Canada (Drs Oh, Chessex, and Grace).
J Cardiopulm Rehabil Prev. 2019 Jul;39(4):226-234. doi: 10.1097/HCR.0000000000000396.
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.
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.
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.
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.
尽管有心脏康复（CR）有效性的证据，但项目之间存在很大的差异，这可能会影响其质量。本研究的目的是：（1）评估我们在国际上衡量 CR 质量的方法；（2）总结我们对 CR 质量和质量改进的了解；（3）推荐提高质量的潜在方法。
本叙述性综述对国际上可用的 CR 质量指标（QIs）进行了文献检索，并咨询了专家。为了实现第二个目标，对 CR 质量文献进行了回顾，并从加拿大心脏康复登记处（CCRR）获得了有关可用 QIs 的数据。为了实现最后一个目标，回顾了可能适用于 CR 环境的医疗保健质量改进策略的文献。
美国、加拿大、欧洲、澳大利亚和日本的 CR 协会制定了 CR QIs。仅在英国、荷兰和加拿大对 CR 质量进行了审核。CCRR 评估了 27 个 QIs。以下指标的 CR 质量较高：促进项目后体力活动、评估血压和与初级保健沟通。质量较低的领域包括提供压力管理、戒烟、在出院总结中纳入推荐的要素以及评估血糖。推荐的提高质量的方法包括患者和提供者教育、提醒系统、组织变革和倡导改善 CR 报销。单独的审核和反馈策略并不成功。
尽管对 CR 质量的了解并不多，但发现了差距。本文推荐的质量改进措施需要进行测试，以确定质量是否可以得到提高。
