Cardiac rehabilitation and secondary prevention (CR/SP) services have proved effective for improving risk factor management and reducing morbidity and mortality among patients with coronary artery disease. As a result, CR/SP services are recognized as a standard of care for patients with cardiovascular disease (CVD).1–6 CR/SP services are provided through an interdisciplinary approach and include specific core components known to optimize cardiovascular risk reduction, foster healthy behaviors and compliance, reduce disability, and promote an active lifestyle for persons with CVD.7 Competent health care professionals from multiple disciplines are essential to the delivery of comprehensive CR/SP services that meet both patient needs and the requirements of a fluid health care environment. The purpose of the article is to update the previous statement of core competencies for CR/SP professionals,8 relate these competencies to the revised core components for CR/SP programs,7 reflect current expectations in providing CR/SP services,9 and integrate a core set of contemporary competency expectations recommended for all health care professionals.10
It is important to understand that defining competence, including specific competencies, is complex and dynamic. Professional competence is a multifaceted concept centered on the integration of core knowledge and skills into clinical practice, but also involving interpersonal skills, lifelong learning, and professionalism.11 Competencies reflect the legal, ethical, regulatory, and political influences on the practice of professionals in health care that are defined as essential for a practitioner within a specific health discipline. Core competencies are used to define a set of measurable indicators required for minimal expectations for performance within a health discipline. Core competencies are used as a framework to align health care providers, educators, students, consumers, and payors with defined expectations for providing care in accordance with evidence-based standards, performance measures, and quality outcomes.12
GENERAL CORE COMPETENCIES FOR HEALTH CARE PROFESSIONALS
The Institute of Medicine (IOM) established quality initiatives designed to help improve quality of care and patient safety.13 Since skilled and knowledgeable health care professionals are needed to implement the transformation of health systems to advance quality, the Health Professional Education Summit was convened to develop a core set of competencies.10 These competencies were developed to address shifts in the US patient population resulting in the patients we serve becoming more diverse, older, and often with numerous comorbidities. The overarching vision from the IOM committee was for educational programs to incorporate the following in their educational and training programs:
All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.10(p45)
Table 1 illustrates the core competencies that all health care professionals should possess, regardless of their discipline, as proposed by the committee convened to meet the needs of today's health care environment.10 These essential core competencies are the basis on which specific core competencies can be built for all health care professionals working in CR/SP programs.
CORE COMPETENCIES FOR CR/SP PROFESSIONALS
Program core components define specific information and skills necessary to provide evidence-based care in CR/SP programs.7 These include comprehensive cardiovascular patient assessment; management of blood pressure, lipids, diabetes, tobacco cessation, weight, and psychological issues; exercise training; and counseling for psychosocial, nutritional, and physical activity issues. This evidence-based document provides the framework for defining core competencies for CR/SP professionals with suggested means for assessment. As previously recommended, provision of care is optimally provided through a case management function, which involves coordination of an interdisciplinary treatment plan.8 Health care professionals involved in providing CR/SP services come from multiple health disciplines, such as medicine, nursing, exercise physiology, physical therapy, clinical nutrition, psychology, social work/counseling.
The American College of Cardiology Foundation, American Heart Association, and American College of Physicians described a curriculum for developing competence among all health care professionals involved in the prevention of CVD.14 Section 16 of that publication specifically addresses recommended knowledge for cardiac rehabilitation and secondary prevention of CVD. The document defines a need for shared responsibility among multiple health care professionals in the prevention of cardiovascular morbidity and mortality. Opportunities for educational resources are critical to ensure the acquisition and maintenance of competence in cardiovascular risk-reduction strategies resulting from expanding knowledge in the field of CR/SP. It is important to acknowledge that each CR/SP health care professional may not necessarily achieve all areas of competencies. Consequently, it is the implementation of the case management approach utilizing the skills and competencies of the multidisciplinary CR/SP team, which will facilitate improved outcomes as measured by requisite studies of morbidity and mortality data.
Table 2 provides recommendations for core competencies in knowledge and skills for CR/SP professionals within each component of care. The organization of core competencies in this systematic approach accomplishes multiple goals. First, it identifies knowledge and skills that are important for professionals working in these programs. Second, it defines appropriate evaluation of skills and knowledge that should be assessed on the basis of professional training, education, certification, or licensure for professionals on the multidisciplinary CR/SP team. Third, it provides guidance to academic programs that prepare students to enter the field of CR/SP. Finally, these core competencies are incorporated into the AACVPR program certification process.15
These core competencies were developed to provide a comprehensive CR/SP program that is consistent with the recommended core components for CR/SP programs.7 The expectation is that 1 single heath care professional does not possess all of the core competencies. Rather, each member of the multidisciplinary CR/SP team, on the basis of education, training, and certifications or licensure, contributes certain core competencies to the team and, together, the team will possess many or all of the core competencies.
We acknowledge that this comprehensive list of core competencies may present challenges for CR/SP programs that are smaller or operate with limited access to resources. Therefore, these core competencies represent the ideal and should be viewed as a goal for all programs to strive to achieve through innovative programming and accessing available resources relevant to the individual CR/SP program.
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cardiac rehabilitation; core competencies; secondary prevention