Development of Quality Indicators for Cardiac Rehabilitation in Australia: A Modified Delphi Method and Pilot Test

Zecchin, R; Candelaria, Dion; Ferry, C.H.; Ladak, Laila Akbar; McIvor, D.; Wilcox, Kerry; Bennett, Alexandra; Bowen, Sheryl Perlmutter; Carr, Bridie; Randall, Sue; Gallagher, Robyn

doi:10.1016/j.hlc.2018.08.004

Cited by 18 publications

(10 citation statements)

References 31 publications

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“…Based on discussions, four statements were increased to an essential rating—this was a result of omitting a singular outlier score of below 7 (as outlined in the RAM guidelines17) and with consensus from the group (table 3). The other topic of discussion was ensuring this work was in line with other national work on quality indicators and minimum data sets 45–49. Our aim was to ensure the programme content was consistent with the indicators and minimum data set requirements.…”

Section: Resultsmentioning

confidence: 99%

“…The CR model in the UK has multiple components at the health system level working towards care reform of secondary prevention services including: minimum standards (as defined by the British Association for Cardiovascular Prevention and Rehabilitation), clinical guidance (provided by the National Institute for Health and Care Excellence) and a National Certification Programme for CR 51. Currently in Australia, there is recognition of the importance of quality in CR, as several states are in the process, or have developed, quality indicators 45–49. There is now work underway to create national quality indicators 60.…”

Section: Discussionmentioning

confidence: 99%

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Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process

et al. 2019

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ObjectiveTo develop standardised programme content for Australian phase II cardiac rehabilitation (CR) programme.DesignUsing the RAND/UCLA appropriateness method (RAM), a two-phase process including a comprehensive literature review and a two round modified Delphi process was undertaken to develop and validate content of a standardised CR programmes.ParticipantsAn invited multidisciplinary expert advisory group (EAG; n=16), including CR health professionals (nurses, allied health professionals, cardiologist), academics, policy makers, representation from the Australian Cardiovascular Health and Rehabilitation Association and consumers, provided oversight of the literature review and assisted with development of best practice statements. Twelve members of the EAG went onto participate in the modified Delphi process rating the necessity of statements in two rounds on a scale of 1 (not necessary) to 9 (essential).Main outcome measureBest practice statements that achieved a median score of ≥8 on a nine-point scale were categorised as ‘essential’; statements that achieved a median score of ≥6 were categorised as ‘desirable’ and statements with a median score of <6 were omitted.Results49 best practice statements were developed from the literature across ten areas of care within four module domains (CR foundations, developing heart health knowledge, psychosocial health and life beyond CR). At the end of a two-round validation process a total of 47 best practice statements were finalised; 29 statements were rated as essential, 18 as desirable and 2 statements were omitted.ConclusionsFor the first time in Australia, an evidence-based and consensus-led standardised programme content for phase II CR has been developed that can be provided to CR coordinators.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process

et al. 2019

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“…These findings are testament to the benefits of the training in terms of increased confidence in a range of areas required for the successful delivery of effective CR. [5,13,[15][16][17] Importantly, the training addresses the key areas of establishing, delivering, maintaining and evaluating a CR program, while attending to issues such as patient health literacy, effective adult education approaches, and effective group interaction.…”

Section: Discussionmentioning

confidence: 99%

“…[2,6,14] For example, CR program coordinators require an understanding of the physiology and pathology of the heart and the causes and comorbidities of heart disease; cardiac investigations, interventions, medications and behavioural approaches to management; occupational, psychological, cognitive and lifestyle impacts of acute events and strategies for supporting recovery in these areas; as well as skills in group facilitation, adult education, program evaluation, and physical and psychosocial screening. [6,13,15] Additionally, coordinators need the organisational and managerial capacity to ensure that quality indicators related to content and timeliness of program delivery are met [16,17] in delivering the core components of CR. In Australia, the core components include: ensuring equity and access to services; undertaking assessment and short-term monitoring; planning recovery and longer term maintenance; facilitating lifestyle/behavioural modification and medication adherence; and undertaking evaluation and quality improvement.…”

Section: Introductionmentioning

confidence: 99%

Impact of intensive training on health professionals’ self-efficacy in establishing, running and maintaining a cardiac rehabilitation program

Murphy

Higgins

Grande

et al. 2019

JNEP

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We developed an intensive five-day training program for health professionals working in cardiac rehabilitation (CR). The training covers topics related to establishing, running, maintaining and evaluating a CR program. The aim of this study was to assess the impact of the training on health professionals’ self-efficacy regarding the effective delivery of CR. From 2014 to 2018, 167 health professionals participated in one of five training programs. Participants completed a 28-item pre- and post-training self-efficacy scale. For a sub-group, self-efficacy was re-assessed 4 months later. Factor analysis was used to identify self-efficacy domains. Paired sample t-tests compared pre- and post-training self-efficacy scores; repeated measures analysis of variance investigated change over the three time points. Variations in self-efficacy across profession, role in CR, and years of CR practice were investigated. Factor analysis identified three domains: Operational aspects of CR; Medical aspects of heart disease; and Psychosocial aspects of CR. Health professionals’ self-efficacy increased significantly after training participation, across the three domains and for the total score. Effects were sustained in the 4-month follow-up. Few variations in self-efficacy trajectories by participant characteristics were identified. The study demonstrates that our health professional CR training significantly improves health professionals’ confidence in a range of areas related to establishing, running, maintaining and evaluating a CR program, with immediate improvements sustained four months later. The pattern of findings was largely consistent regardless of participants’ role and experience in CR. Findings highlight the benefits of this relatively brief intensive program on enhancing the capacity of the CR workforce.

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“…Western Australia, the Northern Territory and Tasmania reported no systematic approach in place for routinely capturing statelevel CR data. It was reported that pilot studies were underway in New South Wales (including data from the Australian Capital Territory and Tasmania) and Victoria, both applying methods by which to extract data from sites using quality indicators developed by New South Wales [15]. An absence of a uniform set of quality indicators (including process and outcome indicators) was identified.…”

Section: Current Approaches To Cr Monitoring and Evaluation In Australiamentioning

confidence: 99%

Improving the Monitoring of Cardiac Rehabilitation Delivery and Quality: A Call to Action for Australia

Thomas

Astley

Gallagher

et al. 2020

Heart, Lung and Circulation

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Development of Quality Indicators for Cardiac Rehabilitation in Australia: A Modified Delphi Method and Pilot Test

Cited by 18 publications

References 31 publications

Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process

Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process

Impact of intensive training on health professionals’ self-efficacy in establishing, running and maintaining a cardiac rehabilitation program

Improving the Monitoring of Cardiac Rehabilitation Delivery and Quality: A Call to Action for Australia

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