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The Quality and Variability of Cardiac Rehabilitation Delivery

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dc.contributor.advisorGrace, Sherry L.
dc.creatorSomanader, Deborah Shiranthi
dc.date.accessioned2015-12-16T19:23:51Z
dc.date.available2015-12-16T19:23:51Z
dc.date.copyright2015-07-27
dc.date.issued2015-12-16
dc.date.updated2015-12-16T19:23:51Z
dc.degree.disciplineKinesiology & Health Science
dc.degree.levelMaster's
dc.degree.nameMSc - Master of Science
dc.description.abstractBackground: Cardiac care, including cardiac rehabilitation (CR), is most effective if it is high-quality. The aim of this study was to describe CR quality, using the recently-developed Canadian Cardiovascular Society CR quality indicators (QIs). As secondary and tertiary objectives, site differences in quality were measured, and the criterion validity of 4 of the QIs in comparison to self-report data were established. Methods: Secondary analysis was conducted on an observational, prospective, multi-site CR program evaluation cohort. A convenience sample of patients from one of 3 CR programs was approached at their first CR visit, and consenting participants completed a survey. Clinical data were extracted from charts pre and post-program. Of the 30 CR QIs, 21 (70.0%) were assessable: 10 process, 9 outcome and 2 structure QIs. Results: Of 411 consenting patients, 209 (53.0%) completed CR. The greatest quality was observed for assessment of blood pressure (98.1%), communication with primary healthcare at CR discharge (94.2%), and patient enrollment (93.7%). The lowest quality was observed for wait time from hospital discharge (9.2%), assessments of blood glucose (42.1%), and lipid control (53.0%). Of the 7 QIs that had an established benchmark, quality for 2 (28.6%) was above the benchmark (particularly assessment of blood pressure). Significant site differences were observed in 11 (64.7%) QIs. The magnitude of quality differences between sites was largest for assessment of lipid control (72.6%), assessment of blood glucose control (69.0%), and wait time in median days from referral to enrollment (30.6 days). Validity was fair for QIs 2a and 3. None to slight validity was found for QI-17, and 18 respectively. Conclusion: There is wide variability in CR program quality, both overall and between CR sites. Quality improvement in particular aspects of CR care is required.
dc.identifier.urihttp://hdl.handle.net/10315/30699
dc.language.isoen
dc.rightsAuthor owns copyright, except where explicitly noted. Please contact the author directly with licensing requests.
dc.subjectHealth sciences
dc.subject.keywordscardiac rehabilitation
dc.subject.keywordshealth services research
dc.subject.keywordsquality
dc.subject.keywordsperformance improvement
dc.subject.keywordscare delivery
dc.titleThe Quality and Variability of Cardiac Rehabilitation Delivery
dc.typeElectronic Thesis or Dissertation

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