Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark

Abstract

A politically initiated national clinical guideline was launched in Denmark in 2013 to improve quality and equality of cardiac rehabilitation (CR) services. The guideline is to be implemented in both hospital and community (municipality) settings due to shared responsibility for provision of CR services. Little is known about implementation outcomes of a guideline in these two settings. We aimed to study this by determining the extent to which Danish CR services in hospitals and municipalities adhered to national recommendations following the launch of the guideline. The study employed an observational, longitudinal design. Data were gathered by a questionnaire survey to compare CR services at baseline, measured in 2013 immediately before the guideline was launched, with CR services at a two-year follow up in 2015. All Danish hospital departments offering CR services (N = 36) and all municipalities (N = 98) were included. Data were analysed using inferential statistics. Hospitals reported improvement of both content and quality of CR services. Municipalities reported no change in content of services, and lower level of fulfilment of one quality aspect. The results suggest that the guideline had different impact in hospitals and municipalities and that the differences in content and quality of services between the two settings increased in the study period, thus contradicting the guideline´s aim of uniform, evidence-based content of CR services across settings.

Access to cardiac rehabilitation and the role of language barriers in the provision of cardiac rehabilitation to migrants

“…The questionnaires were complied using the recommended national clinical guideline regarding the coverage of core CR components. A more detailed description of the survey can be found elsewhere [31]. Hospital-based questionnaires were derived from the DHRD, which collects programme-level CR data.…”

Municipality-based pragmatic rehabilitation stratified in accordance with individual needs—results from a longitudinal survey study

“…lymphatic drainage) being provided by hospitals [8]. A newly published Danish study on cardiac rehabilitation demonstrated that guidelines and recommendations may have a different impact in hospitals and municipalities; municipalities were less likely to improve content of services, and demonstrated lower performance on quality aspects [9]. Thus, it is important to monitor municipality-based rehabilitation services closely.…”

Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database

“…In the current study, we regard the use of data to be relatively low as only 29% of frontline staff and 50% of heads of department in the present study reported to carry out data-driven improvements based on results in the registry, and less than one in three present results to members of staff. Furthermore, in a previous study we identified gaps between evidence and practice in nearly all departments providing cardiac rehabilitation in Denmark 18…”

“…CQRs are typically introduced in clinical areas where there is a gap between evidence and practice 3. One such area is cardiac rehabilitation, which despite being an important part of secondary prevention for patients recovering from heart disease,16 is consistently reported to have evidence-practice gaps 17 18. CQRs with the purpose of monitoring and improving cardiac rehabilitation services have been established in at least seven countries 19.…”