National quality indicators to promote cardiac rehabilitation service effectiveness in Australia

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Gallagher ◽  
C Astley ◽  
E Thomas ◽  
R Zecchin ◽  
C Ferry ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Quality Indicators ◽  
Business Models ◽  
Cardiovascular Health ◽  
National Level ◽  
Clinical Effectiveness ◽  
Rehabilitation Service ◽  
Service Improvement ◽  
Consistency Checking ◽  
National Quality

Abstract Background/Introduction Comprehensive exercise-based cardiac rehabilitation (CR) has well-established efficacy and effectiveness for improving patients' outcomes. There is substantial variability in terms of clinical effectiveness and quality measurement of CR programs internationally which limits service improvement initiatives. In Australia in 2018 a the Australian Cardiovascular Health and Rehabilitation Association (ACRA) and the National Heart Foundation of Australia (NHFA) combined forces to develop nationally-agreed, internationally-consistent, locally-relevant quality indicators (QI). Purpose To provide a minimum set of standardised national-level QI that should be collected and reported on by CR programs to determine the quality of delivery and associated outcomes, benchmark performance and support improvement processes. Methods We formed the National Cardiac Rehabilitation Measurement (NCRM) Taskforce led by ACRA and NHF and used the National Institute for Health and Care Excellence (NICE) UK guidelines to develop high quality QIs. The process included topic overview, prioritising areas for quality improvement, drafting and consultation, validation and consistency checking. Results Eleven preliminary QIs were circulated for ranking and comment to all ACRA members (predominately multidisciplinary CR providers) (68 responses), and to leading national multidisciplinary CR experts from cardiology, research, physiotherapy, nursing, epidemiology and register backgrounds (7 responses). Ratings, comments and suggestions were collated and discussed by the NCRM Taskforce, and the indicators rated most important, useful and feasible were retained, resulting in 10 QIs. These 10 QIs were presented at the ACRA national conference and then discussed at a workshop (55 participants) for this purpose. Ten QIs and accompanying data dictionary with definitions, evidence and allowable values is the final product. Conclusions A minimum set of locally relevant, internationally recognised, national QIs for CR is now available for CR providers, health service managers and researchers in Australia, which may be relevant internationally. The QIs will best serve national interests incorporated within a national cardiac registry but will also be useful for site audits and have strong potential to be aggregated across sites, health districts and states. The definitive test of the QIs will be how useful they are for CR program coordinators and funders of such programs; a key consideration for building sustainable business models and ensuring long-term implementation. Funding Acknowledgement Type of funding source: None

scholarly journals Cardiac Rehabilitation in the Region of Veneto

2005 ◽  
Vol 64 (2) ◽  
Author(s):  
Roberto Carlon
Keyword(s):  
Cardiac Rehabilitation ◽  
Intensive Therapy ◽  
National Level ◽  
Detailed Account ◽  
Rehabilitation Service ◽  
Eligibility Criteria ◽  
Regional Plan ◽  
Organizational Requirements

In Italy there has been a progressive shifting of the legislative and fiscal activity from a national level to a regional one. In the Venetian district a series of documents, also concerning the cardiac rehabilitation, has been produced. A document elaborated in 1999 contains a detailed account of eligibility criteria for cardiac rehabilitation as well as of structural and organizational requirements. Other documents contain the updated price lists for admission episode (DRG 462) or days of stay in hospital and diurnal hospital activity, according to the type of structure which supplies the service. For outpatients, cardiac rehabilitation is identified by the code 93.36 and the ticket fare is 19,50€. In the enclosure no.6 of the Sanitary Regional Plan, still under definitive approval, it is stated that for each Intensive Therapy there will be a functional connector with a cardiac rehabilitation service which, except for few Centers, will carry on its activity with outpatients. At present the regional Cardiac Rehabilitation includes 3 complex units (for in- and outpatients) and 13 simple units (for outpatients only), with a total of 3031 patients rehabilitated in 2004.

scholarly journals Home-based Cardiac Rehabilitation: the patients claim for new strategies but do they adhere?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Alves Da Silva ◽  
I Aguiar-Ricardo ◽  
N Cunha ◽  
T Rodrigues ◽  
B Valente-Silva ◽  
...  
Keyword(s):  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Cardiovascular Health ◽  
Training Session ◽  
Educational Status ◽  
Drop Out ◽  
Therapeutic Adherence ◽  
Validated Questionnaire ◽  
Home Based ◽  
Degree Of Participation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation (CR) programs are established interventions to improve cardiovascular health, despite asymmetries in referral. With covid 19 outbreak, cardiac rehabilitation home based (CR-HB) programs emerged as an alternative. However, its adherence and implementation may vary greatly with socio-demographic factors. Purpose To assess adherence to the various components of a CR-HB program.  Methods Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.patient clinical and exercise risk assessment; 2.psychological tele-appointments; 3. online exercise training sessions; 4.structured online educational program for patients and family members/caregivers;  5. follow-up questionnaires; 6. nutrition tele-appointments; 7. physician tele-appointments Adherence to the program was assessed by drop-out rate; number of exercise sessions in which each patient participated; number of educational sessions attended and a validated questionnaire on therapeutic adherence (composed of 7 questions with minimum punctuation of 7 and maximum of 40 points). Results 116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure; the mean LVEF was 52 ± 11%. Regarding risk factors, obesity was the most common risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%).  Ninety-eight pts (85.5%) successfully completed the program. Almost half (46.9%) of the participants did at least one online exercise training session per week. Among the pts who did online exercise training sessions, 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week.  The pts participated, on average, in 1.45 ± 2.6 education sessions (rate of participation of 13,2%) and therapeutic adherence was high (39,7 ± 19; min 35-40).  Regarding educational status of the pts, 33 pts (45,2%) had a bachelor degree. These pts tended to participate more in exercise sessions (1,7 ± 1,7 vs 1,2 ± 1,4 sessions per week) and in education sessions (2.13 vs 1.6), although this difference was not statistically significant. The therapeutic adherence did not vary with patients’ level of education.  Conclusion Our results showed that a high percentage of patients completed the program and almost half were weekly physically active. However, in regard to educational sessions, the degree of participation was much lower. Educational status seemed to correlate with a higher degree of participation and, in the future, patient selection might offer better results in these kinds of programs.

scholarly journals How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046051
Author(s):  
Alasdair F O'Doherty ◽  
Helen Humphreys ◽  
Susan Dawkes ◽  
Aynsley Cowie ◽  
Sally Hinton ◽  
...  
Keyword(s):  
High Risk ◽  
Cardiac Rehabilitation ◽  
Technology Use ◽  
Healthcare Professionals ◽  
Hospital Admissions ◽  
Well Being ◽  
Rehabilitation Service ◽  
High Risk Patients ◽  
Home Based ◽  
Risk Patients

ObjectiveTo investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation.DesignA mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety.SettingInternational survey of exercise-based cardiac rehabilitation programmes.ParticipantsHealthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide.Main outcome measuresThe proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation.ResultsThree hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing.ConclusionsThe rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.

The effect of train-the-colonoscopy-trainer course on colonoscopy quality indicators

Endoscopy ◽  
2021 ◽  
Author(s):  
Geir Hoff ◽  
Edoardo Botteri ◽  
Gert Huppertz-Hauss ◽  
Jan Magnus Kvamme ◽  
Øyvind Holme ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Estimating Equation ◽  
First Year ◽  
Polyp Detection ◽  
Detection Rates ◽  
Quality Register ◽  
Polyp Detection Rate ◽  
National Quality ◽  
Systematic Training ◽  
Colonoscopy Quality

Abstract Background Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of “training-the-colonoscopy-trainer” (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators. Methods This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used. Results 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period. Conclusions Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up.

Peer Review of Paediatric Endocrine Services in the UK: A Template for Quality and Service Improvement

2021 ◽  
pp. 1-6
Author(s):  
John Schulga ◽  
Heather Mitchell ◽  
S. Faisal Ahmed ◽  
Assunta Albanese ◽  
Justin Warner ◽  
...  
Keyword(s):  
Peer Review ◽  
National Level ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
British Society ◽  
Service Improvement ◽  
Paediatric Endocrinology ◽  
Test Feasibility ◽  
Specialist Nurses ◽  
The Uk

<b><i>Background:</i></b> Independent peer review of healthcare services can complement existing internal-, institutional-, and national-level regulatory mechanisms aimed at improving quality of healthcare. However, this has not been reported for paediatric endocrinology services in the UK. We aimed to test feasibility and acceptability through a first cycle of a national peer review of paediatric endocrine services. <b><i>Methods:</i></b> Tertiary centres in paediatric endocrinology across the UK were assessed against 54 quality standards, developed by the British Society for Paediatric Endocrinology and Diabetes (BSPED) in five domains of healthcare by a team comprising paediatric endocrinologists and specialist nurses. The evaluation was supported by a self-assessment. A post-peer-review questionnaire was used as feedback. <b><i>Results:</i></b> All 22 centres in the UK underwent independent peer review between 2011 and 2017. Each served a median population of 2.6 million (range 1–8 million) and offered 1,872 (range 779–6,738) outpatient consultations annually. A total of 43 (range 30–49) standards were met in combined evaluation of all centres. Variance of adherence for essential standards ranged from 52 to 97% at individual centres with 90% adherence demonstrated by 32% of centres. Post-review feedback showed 20/22 (95%) validating the utility of the peer review. <b><i>Conclusions:</i></b> The BSPED peer review of all UK centres providing paediatric endocrine services is shown to be feasible and provides a quality benchmark for replication by national services.

scholarly journals The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals

2013 ◽  
Vol 34 (4) ◽  
pp. 437-439 ◽  
Author(s):  
Adam Weston ◽  
Lauren Epstein ◽  
Lisa E. Davidson ◽  
Alfred DeMaria ◽  
Shira Doron
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Educational Program ◽  
Business Models ◽  
National Level ◽  
State Level ◽  
Acute Care Hospitals ◽  
The State ◽  
Team Approach ◽  
The Impact

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

P1743Assessment of quality of care of patients with ST-segment elevation myocardial infarction in Poland

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Hudzik ◽  
A Budaj ◽  
M Gierlotka ◽  
A Witkowski ◽  
W Wojakowski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Quality Of Care ◽  
Cardiac Rehabilitation ◽  
Quality Indicators ◽  
Medical Therapy ◽  
Patient Reported Outcomes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Patient Reported

Abstract Introduction 2017 ESC Guidelines for the management of ST-elevation myocardial infarction (STEMI) patients have called for the assessment of the quality of care to establish measurable quality indicators in order to ensure that every patient with STEMI receives the best possible care. We investigated the quality indicators of health care services in Poland provided to STEMI patients. Methods The Polish Registry of Acute Coronary Syndromes (PL-ACS) is an ongoing, nationwide, multicenter, prospective, observational study of consecutively hospitalized patients with the whole spectrum of ACS in Poland. For the purpose of assessing quality indicators, we included 8,279 patients from the PL-ACS Registry hospitalized with STEMI between January 1 and December 31, 2018. Results All emergency medical services (EMS) are equipped with ECG/defibrillators. 408 of 8,279 patients (4.9%) arrived at PCI center by self-transport, 4,791 patients (57.9%) patients arrived at PCI center by direct EMS transport, and 2,900 patients (37.2%) were transferred from non-PCI facilities. Whilst 95.1% of STEMI patients arriving in the first 12 hours received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various STEMI pathways). 7,807 patients (94.3%) underwent PCI as a mode of primary reperfusion strategy. The median left ventricular ejection fraction (LVEF) was 46% and was assessed before discharge in 86.0% of patients. 489 of 8,279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50–85% of patients depending on various clinical settings. Only one in two STEMI patient is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the PL-ACS Registry. Figure 1 Conclusions The results of this study identified areas of healthcare systems that require solid improvement. These include prehospital ECG decision strategy, direct transport to PCI center, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. More importantly, we recognized an urgent need for the initiation of recording quality indicators associated with patient-reported outcomes.

scholarly journals Transforming Universities for the Digital Age - Policies – Business Models – Resources

2019 ◽  
Vol 5 (4) ◽  
Author(s):  
Eva Szalma
Keyword(s):  
Higher Education ◽  
Business Models ◽  
Career Guidance ◽  
Student Mobility ◽  
Classical Model ◽  
National Level ◽  
The European Union ◽  
Institutional Leadership ◽  
Strategic Factor ◽  
E Learning

Higher education systems in the European Union are operating in an increasingly fast-changing and competitive environment. They have to tackle key issues dealing with massification, career guidance, cost-efficiency, international attractiveness, student mobility. At a more operational level, digital practices and technologies support the change of several aspects of higher education institutions and new players providing expertise and methodologies undermine the classical model of university as a leading knowledge producer and disseminator.Such major transformations require modern governance arrangements and dynamic leadership. As outlined in the EU Modernization Agenda of Higher Education (2011), the major bottleneck found is the staff competence and preparedness, more specifically at the institutional leadership and executive management level.The interest for e-learning is not new but contrary to the obvious interest for equipment or management, this has not been enough for e-learning to impose itself. As stated by Paul Bacsich (2011) the presence of ICT in universities is a reality but the education transformation has not yet taken place. So far, initiatives are generally focused on operational (managerial) aspects. The D-TRANSFORM project starting in 2014 and ending in 2017[1] was the first European-funded project focusing on the fundamental strategic aspects of digital innovation of Higher Education. Through leadership schools, MOOCs, guidelines and stat-of-the-art reports it helped university governing bodies to define their own digital strategies and coordinate them with public policies defined at the European/national level and to be able to plan e-education according to the university needs and profile.[1] DigiTal Resources As a New Strategic FactOr for a Renovation and Modernization in HEType: Initiative supported by the ERASMUS+(2014- 2017)Budget: 1 M$

Media or Corporations? Social Media Governance Between Public and Commercial Rationales

2020 ◽  
pp. 249-268
Author(s):  
Daniela Stockmann
Keyword(s):  
Social Media ◽  
Business Models ◽  
Hate Speech ◽  
Self Regulation ◽  
National Level ◽  
Personal Data ◽  
Media Companies ◽  
Active User ◽  
Corporate Governance Codes ◽  
Over Time

In public discussions of social media governance, corporations such as Google, Facebook, and Twitter are often first and foremost seen as providers of information and as media. However, social media companies’ business models aim to generate income by attracting a large, growing, and active user base and by collecting and monetising personal data. This has generated concerns with respect to hate speech, disinformation, and privacy. Over time, there has been a trend away from industry self-regulation towards a strengthening of national-level and European Union-level regulations, that is, from soft to hard law. Hence, moving beyond general corporate governance codes, governments are imposing more targeted regulations that recognise these firms’ profound societal importance and wide-reaching influence. The chapter reviews these developments, highlighting the tension between companies’ commercial and public rationales, critiques the current industry-specific regulatory framework, and raises potential policy alternatives.

Sign in / Sign up

Export Citation Format

Share Document