Quality and Variability of Cardiovascular Rehabilitation Delivery: Applying the Canadian Quality Indicators

Purpose: 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). CR site differences in quality were also assessed. 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 411consenting 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(94.0%). 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 QI s 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).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.