Revision of the Dutch clinical algorithm for assessing patient needs in cardiac rehabilitation based on identified implementation problems

Engen-Verheul, Mariëtte M. van; Kemps, Hareld; Keizer, Nicolette F. de; Hellemans, Irene; Goud, Rick; Kraaijenhagen, Roderik A.; Peek, Niels

doi:10.1177/1741826711408148

Cited by 11 publications

(11 citation statements)

References 31 publications

(29 reference statements)

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“…Patients entering outpatient CR in the Netherlands are offered a comprehensive, individualized rehabilitation programme with a typical duration of 6–12 weeks, consisting of one or more of the four group-based therapies supplemented by individual counselling when indicated. Consistent with international guidelines, the Dutch guidelines for CR [22, 23] state that the individualized programme should be based on a need assessment procedure where data items concerning the patient’s physical and psychosocial condition are gathered.…”

Section: Methodsmentioning

confidence: 99%

“…Concordant prescribing was defined as prescribing a therapy for patients who were indicated to receive it and not prescribing a therapy for patients who were not indicated to receive it according to the Dutch clinical CR guidelines [22, 23]. Additionally, we measured change in concordance with respect to actual attendance of these four therapies by patients.…”

Section: Methodsmentioning

confidence: 99%

“…At the time we conducted our study, two commercial vendors of EPR systems for CR were available in the Netherlands. Both systems incorporated the Dutch CR guidelines [22, 23] and followed the same data model. Data collection was structured as part of the needs assessment procedure and fed into the CDS module providing prescription recommendations for each of the four CR therapies [27].…”

Section: Methodsmentioning

confidence: 99%

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Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation

et al. 2016

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BackgroundThe objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams.MethodsWe performed a multicentre cluster-randomized trial within the field of comprehensive cardiac rehabilitation (CR) in the Netherlands. Our participants were multidisciplinary teams in Dutch CR centres who were enrolled in the study between July 2012 and December 2013 and received the intervention for at least 1 year. The intervention included web-based A&F with feedback on clinical performance, facilities for goal setting and action planning, and educational outreach visits. Teams were randomized either to receive feedback that was limited to psychosocial rehabilitation (study group A) or to physical rehabilitation (study group B). The main outcome measure was the difference in performance between study groups in 11 care processes and six patient outcomes, measured at patient level. Secondary outcomes included effects on guideline concordance for the four main CR therapies.ResultsData from 18 centres (14,847 patients) were analysed, of which 12 centres (9353 patients) were assigned to group A and six (5494 patients) to group B. During the intervention, a total of 233 quality improvement goals was identified by participating teams, of which 49 (21%) were achieved during the study period. Except for a modest improvement in data completeness (4.5% improvement per year; 95% CI 0.65 to 8.36), we found no effect of our intervention on any of our primary or secondary outcome measures.ConclusionsWithin a multidisciplinary setting, our web-based A&F intervention engaged teams to define local performance improvement goals but failed to support them in actually completing the improvement actions that were needed to achieve those goals. Future research should focus on improving the actionability of feedback on clinical performance and on addressing the socio-technical perspective of the implementation process.Trial registration NTR3251

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation

et al. 2016

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“…In fact, in line with the EACPR recommendations, the Netherlands Society for Cardiology (NVVC) has developed a clinical algorithm for assessment of patient needs for CR [20,21], which recommends SET for all patients entering outpatient CR, including gas exchange analysis for CHF patients. Clearly, our study shows that these recommendations are not well implemented in Dutch CR centres.…”

Section: Discussionmentioning

confidence: 99%

Exercise training programs in Dutch cardiac rehabilitation centres

et al. 2013

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Purpose To assess methods for determination of exercise intensity, and to investigate practice variation with respect to the contents, volume and intensity of exercise training programs in Dutch cardiac rehabilitation (CR) centres. Methods A paper questionnaire was sent to all Dutch CR centres, consisting of 85 questions for patients with an acute coronary syndrome (ACS) or after coronary revascularisation (Group 1) and for patients with chronic heart failure (CHF, Group 2). Results CR professionals from 45 centres completed the questionnaires (58 %). Symptom-limited exercise testing was used to determine exercise capacity in 76 % and 64 % of the CR centres in group 1 and group 2, respectively; in these centres, a percentage of the maximum heart rate was the most frequently used exercise parameter (65 % and 56 %, respectively). All CR centres applied aerobic training and the majority applied strength training (64 % in group 1 and 92 % in group 2, respectively). There was a considerable variation in training intensity for both aerobic and strength training, as well as in training volume (1-20 h and 1-18 h respectively).

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“…ACS is defined as persistent (>20 min) chest pain suggestive of myocardial ischaemia, which is unresponsive to nitroglycerin and which is accompanied by ST-T changes (electrocardiographic evidence) and/or cardiac troponin elevations (biochemical evidence), regardless of in-hospital treatment. A total of 10 hospitals in the broader region of Rotterdam—The Hague refer their ACS patients to the local Capri Centre, which offers a standard CR program that is consistent with the Dutch guidelines [23, 24]. …”

Section: Methodsmentioning

confidence: 99%

OPTImal CArdiac REhabilitation (OPTICARE) following Acute Coronary Syndromes: Rationale and design of a randomised, controlled trial to investigate the benefits of expanded educational and behavioural intervention programs

et al. 2013

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The majority of cardiac rehabilitation (CR) referrals consist of patients who have survived an acute coronary syndrome (ACS). Although major changes have been implemented in ACS treatment since the 1980s, which highly influenced mortality and morbidity, CR programs have barely changed and only few data are available on the optimal CR format in these patients. We postulated that standard CR programs followed by relatively brief maintenance programs and booster sessions, including behavioural techniques and focusing on incorporating lifestyle changes into daily life, can improve long-term adherence to lifestyle modifications. These strategies might result in improved (cardiac) mortality and morbidity in a cost-effective fashion. In the OPTImal CArdiac REhabilitation (OPTICARE) trial we will assess the effects of two advanced and extended CR programs that are designed to stimulate permanent adaption of a heart-healthy lifestyle, compared with current standard CR, in ACS patients. We will study the effects in terms of cardiac risk profile, levels of daily physical activity, quality of life and health care consumption.

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Revision of the Dutch clinical algorithm for assessing patient needs in cardiac rehabilitation based on identified implementation problems

Cited by 11 publications

References 31 publications

Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation

Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation

Exercise training programs in Dutch cardiac rehabilitation centres

OPTImal CArdiac REhabilitation (OPTICARE) following Acute Coronary Syndromes: Rationale and design of a randomised, controlled trial to investigate the benefits of expanded educational and behavioural intervention programs

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