1. Developing a cardiac rehabilitation program outline in Victoria – methods and preliminary results
Dr Susie Cartledge, on behalf of:
Deakin IPAN: Emma Thomas, Professor Ralph Maddison
National Heart Foundation of Australia: Kerry Hollier, Roni Beauchamp, Dr Sue Forrest
Pleasure to present this work
I am representing a large group of people who are currently working hard on this project
From Deakin University- Emma Thomas, Ralph Maddison
From National Heart Foundation of Australia - Kerry Hollier, Roni Beauchamp and Sue Forrest
In addition to some expert advisors who I will describe later
- Highlight work in progress – take you through the steps of this project

2. Cardiac rehabilitation in Australia
Lacking information to guide CR clinicians on components of what to deliver
Lack of program standardisation
No CR guidelines in Aus
High level recommendations but nothing clinician can pick up and run with
No program standardisation
Regardless of mode of delivery; telephone, mobile health
Really see this as a small piece of work in a larger puzzle- which I will touch on towards the end of the presentation
Project funded by the Victorian Government through Safer Care Victoria (SCV)
ACRA involvement

3. Aims
Develop a program outline and resource for Phase II cardiac rehabilitation that is:
Victorian focus currently, but hope expand to national focus in the future
Evidence based – we know that the cardiology community wants to see an EB program so they can feel confident about what they are referring their patients to
Vic focus- feel climate is particularly good for a national approach- g
Evidence based
Standardised
Builds on ACRA Core Components
Client centred
Focuses on the content to be delivered rather than method of delivery
iven that there are national working groups both on this project and others- discuss more at the end

4. - Patient satisfaction literature - Consumer reps - Site visits
- Guidelines
- Cochrane
- Other Systematic
Reviews
- RCTs
- Expert advisory
group
- ACRA Vic Forum
Best research evidence
Clinical
expertise
Consumer values and preferences
- Patient satisfaction
literature
- Consumer reps
- Site visits
Local context
Bringing together all the different forms of the evidence
Deakin input academic advisors for BRE section assisting with input to other sections

5. Methods – module development
Content area determined by literature review
Evidence mapped to form modules
Additional literature review for each module if gaps identified
Content expert reviews module
Module review by expert advisory group
All modules reviewed by ACRA Vic members
Module finalised by working group

6. Results – module overview
Cardiac Rehabilitation Foundations
- Initial assessment
- Education and self-management
Psychosocial
Psychological well-being
Social support & intimacy
Developing skills to take care of heart health
Exercise
Nutrition and body composition
Medication concordance
Tobacco & alcohol
Long term
Skills beyond CR
Returning to ADLs
Final assessment and long term goals

7. Expert Advisory Group
What a bunch of good looking people! Not to mention talented and experienced. We have tried to include:
CR clinicians- including cardiologist and diverse range of professions included (EP, PT, psychology)
Academics
ACRA representation
HF representation
National membership
+ input from other content experts along the way – such as pharmacist, QUIT etc.

8. Standardisation – Delphi process
Core deliverables
Desirable
Median score 8 – 9, without disagreement
Median score 5 – 7, without disagreement
Aware that not all programs have access to the same things. When developing this really keep in mind of the small rural program with limited resources
Describe two round Delphi process via Qualtrics and second round includes teleconference meeting

9. CR projects around Australia
9.5.18
Opportunity to scope what is happening in the Australian CR space currently
Opportunity to take this work further, both in Vic and expand nationally
The time is perfect – national working parties already formed for other projects and could move forward with next stream of work

10. What next? National approach Governance National CR guidelines
National quality indicators
Monitoring of quality of care delivery (e.g. registry)
What next? Not just in terms of this project but in terms of Cardiac Rehabilitation in Australia?
The challenge for all of us here at this conference and all in the CR community is how can we draw all of this together
Climate is good. CR is priority for HF. HF now national entitiy. National CR discussions already beginning.
Next steps:
Governance
National CR guideline – that is embedded within ACS / cardiac guidelines
National Qis – we are seeing some progress in this area with a national meeting scheduled in the next few months
Auditing and monitoring – requires a registry

11. Guidelines Audit Governance Quality indicators Registry
Quality improvement
2002
Development of stroke guidelines
2007
Established the National Stroke Audit Program
(now run by AusDaT)
2008
ASC established bringing together an alliance of organisations with the common missing of improving stroke care
2008
Developed national quality indicators
2009
Australian Stroke Clinical Registry (AuSCR) was piloted
Ongoing
Can we follow in the footsteps of stroke rehabilitation?
Over the last two decades Stroke have been developing guidelines, auditing rehabilitation, and now have a very well established registry and ongoing health reform initiatives.
Crucial to this success was strong governance, a national strategic plan, coordinated advocacy and a common voice.
Stroke have been able to implement these things- and have a blueprint for success. We should be planning to follow a similar process which is driven at a national level

12. Acknowledgements Expert Advisory Group: Ms Emma Boston
Professor Robyn Gallagher
Ms Kim Gray
Dr Adrienne O’Neil
A/Prof Julie Redfern
Ms Cate Ferry
Mrs Beth Meertens
A/Prof Nick Cox
Dr Bridget Abell
Prof Lis Neubeck
Dr Carolyn Astley
Prof Robyn Clark
Ms Maria Sheehan
Mr Stephen Woodruffe
Dr Rosemary Higgins
Additional content specialists
Ms Sian Armstrong
Ms Cia Connell
Sarah White

13. Questions. Project manager: Kerry. Hollier@heartfoundation. org
Questions? Project manager: Deakin IPAN: