1. Establishing a NSW cardiac rehabilitation minimum dataset (CRMDS).
Robert Zecchin (1*), Cate Ferry (2), Dawn McIvor (3, 5), Kerry Wilcox (4), Jane Kerr (5), Sasha Bennett (6), Sheryl Bowen (7), Bridie Carr (8), Phillip Newton (9), Robyn Gallagher (3, 10).
1. Western Sydney Local Health District (LHD)
2. Heart Foundation (HF) NSW Division Cardiovascular Health Rehabilitation Association (CRA) NSW & ACT
4. Northern NSW LHD
5. Hunter New England LHD
6. Therapeutic Advisory Group (TAG) NSW Mid-North Coast LHD
8. Agency for Clinical Innovation (ACI) NSW
9. University of Technology Sydney;
10. University of Sydney
Introduction
Methods
NSW CR MDS Quality Indicators
There is a paucity of data for cardiac rehabilitation (CR) services and its outcomes across Australia, and in particular NSW.
NSW CR services were required to provide monthly reports to the NSW Ministry of Health (MoH) until recently as it provided very limited information.
Both the HF and ACRA recently stated that all CR services must collect a minimum set of data and report on key performance indicators to promote continuous quality improvement of services and benchmarking.
The aim of this paper is to ascertain current status of data collection and recommend quality indicators for monitoring CR services in NSW.
A proposed dataset in NSW should:
Start with a small number of indicators
Ensure an evidence-base linkage between data collection and outcomes
Use standard definitions/develop a data dictionary
Link data with established Health and Quality Standards to ensure/facilitate uptake.
Able to compare between datasets – both national and internationally
Under the auspices of the HF NSW, CRA NSW and ACI, a CRMDS Working Group was established to formulate a minimum dataset, and a supporting data dictionary, through a process of review, deliberation, and consensus.
The HF conducted a survey in May 2014 which reviewed current CRMDS practices in NSW.
Principal Referral Diagnosis = The referral diagnosis refers to the most recent diagnosis preceding the patient’s referral to cardiac rehabilitation.
Interventions/Complications = This refers to the most relevant additional diagnosis/intervention/complication as a result of the principal diagnosis prior to cardiac rehabilitation.
CR wait time = from date of discharge to commencement of CR Service.
Assessment of adiposity = change (%) of waist circumference at post program from baseline.
Assessment of evidence-based ACS and/or CCF medication = percentage (%) of patients pre CR and post CR.
Increase in exercise capacity = Percentage of CR patients with increase in exercise capacity at post CR assessment
Assessment of depression = Percentage of CR patients with assessment for depression with a validated tool.
Referral of patients screening positive for > moderate depression = Percentage of CR patients with suspected depression referred for mental health management.
Smoking cessation and support = Percentage of CR patients who are current or recent smokers referred to and/or given smoking cessation advice/counselling.
Symptom-Management Plan = The percentage of patients in the CR program who received patient symptom-management education either individually or within a group prior to program discharge.
CR program completion = Percentage of CR patients completing the program and reason for dropout/non-adherence.
Ongoing care = Referral of patients to ongoing care during and/or after completion of Phase 2 CR Program.
CR Clinical Indicators Survey 2014
CR clinicians were sent the a survey monkey questionnaire containing 11 questions.
84 responses, 82% of respondents were nurses.
Respondents rated the following clinical indicators, in order of the most important, to collect to monitor the performance of the CR service.
78% - medication adherence to guideline therapy
76% - smoking status
75% - a psychological profile including screening for depression
73% - an individualised assessment for CVH risk factors
73% a symptom self- management plan
65% functional capacity assessment e.g. 6 minute walk test
54% early communication with GP
How many and how often should the indicators be collected?
25% of respondents indicated it would be feasible to collect 6 indicators in their CR service.
35% indicated collecting indicators on a quarterly basis was the preference rather than monthly, six monthly or annual collection.
83% indicated they would use the data to improve or effect change, and 75% indicated they would use the data to benchmark with other CR services.
How is data currently collected?
52% of respondents manually collect clinical indicators in their service
30% electronically and
14% currently didn't collect clinical indicators.
The Drivers
Improving the delivery of cardiac rehabilitation in Australia - The Heart Foundation’s Cardiac Rehabilitation Advocacy Strategy (2014)
As part of the Heart Foundation For all Hearts 2013–2017 strategic plan, we have developed a strategy to improve CR service provision in Australia. One of the six key priority areas for action is: Establish uniform quality performance measures, data collection and routine reporting. National initiatives for monitoring cardiac/cardiac rehabilitation services:
Stephen Woodruffe, Lis Neubeck, Robyn A. Clark, Kim Gray, Cate Ferry, Jenny Finan, Sue Sanderson, Tom G. Briffa Australian Cardiovascular Health and Rehabilitation Association (ACRA) Core Components of Cardiovascular Disease Secondary Prevention and Cardiac Rehabilitation Heart, Lung and Circulation (2015) 24, 430–441.
Australian Commission on Safety and Quality in Health Care Acute Coronary Syndromes Clinical Care Standard. Sydney: ACSQHC, 2014.
Australian Commission on Safety and Quality in Health Care and NSW Therapeutic Advisory Group Inc National Quality Use of Medicines Indicators for Australian Hospitals. Sydney: ACSQHC, 2014.
Current Status / Conclusions
Between March 1st and May 30th the NSW CRMDS has been field tested in metropolitan, rural and remote CR settings to ensure rigour.
The data collected will identify CR service gaps, provide information for service provision and enhancement, help drive quality improvement and deliver attainment of best practice in CR across NSW.
This process and its outcomes may be translated towards an Australian minimum dataset and the introduction of national KPIs for CR.