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Feasibility of Assessing 2 Cardiac Rehabilitation Quality Indicators

Grace, Sherry L. PhD; Tan, Yongyao MSc; Oh, Paul MD; Aggarwal, Sandeep MD; Unsworth, Karen BPE, MSc; Suskin, Neville MBChB, MSc, FRCPC

Journal of Cardiopulmonary Rehabilitation and Prevention: March/April 2016 - Volume 36 - Issue 2 - p 112–116
doi: 10.1097/HCR.0000000000000136
Brief Report

PURPOSE: The Canadian Cardiovascular Society initiated a pan-Canadian process for development of quality indicators (QIs) for cardiac rehabilitation (CR). Before implementation, the QIs underwent pilot testing to ensure they were acceptable and feasible for field implementation. The objectives of this test were to assess (1) the technical feasibility of measuring the QIs; (2) the workload required to measure the QIs; and (3) acceptability of measuring the QIs and issues with their implementation.

METHODS: The 2 indicators chosen for field testing were QI-1 (% of eligible inpatients referred) and 2b (median wait time from CR referral receipt to enrollment). The approach consisted of 3 steps: (1) data extraction to test technical feasibility; (2) completing a workload diary; and (3) providing input through a semistructured interview regarding acceptability and implementation issues. Three academic CR sites were selected to undertake the field test.

RESULTS: QI-1 ranged from 51.0% to 68.4%, and QI-2b was reported as 27 days (median) by one site, and 22 days (mean) by another. It was not considered feasible for CR programs to assess all potentially CR-eligible inpatients for CR referral exclusions. Compilation required 4.2 hours for QI-1 and 1.8 hours for QI-2b. QI assessment was acceptable to the programs, but changes in practice would be needed at each site to implement the QIs.

CONCLUSIONS: CR programs may require enhancement of information-tracking processes to enable QI measurement. It was recommended that the QIs be implemented, but should undergo minor revisions to enhance feasibility.

Supplemental Digital Content is Available in the Text.Two Canadian cardiac rehabilitation (CR) quality indicators (QI), namely inpatient referral and wait time, underwent pilot-testing for acceptability and implementation feasibility. QI assessment was highly acceptable to the academic CR community. There were issues raised regarding inclusions and exclusions for the first QI, which should be addressed before national roll-out.

York University (Dr Grace), Toronto, Ontario, Canada; University Health Network (Dr Grace, Mr Tan, and Dr Oh), Toronto, Ontario, Canada; Total Cardiology (Dr Aggarwal), Calgary, Alberta, Canada, St Joseph's Health Care London (Ms Unsworth and Dr Suskin), London, Ontario, Canada; and Western University (Dr Suskin), London, Ontario, Canada.

Correspondence: Sherry L. Grace, PhD, York University, Bethune 368, 4700 Keele St, Toronto, ON M3J 1P3, Canada (

The data presented in this article stem from a study supported by the Canadian Cardiovascular Society through a professional services contract. The Public Health Agency of Canada has funded the Canadian Cardiovascular Society to undertake this project.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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