A co-designed telehealth-based model of care to improve attendance and completion to cardiac rehabilitation of rural and remote Australians: The Country Heart Attack Prevention (CHAP) project

We aim to report the co-design of the implementation strategy of a telehealth-enabled cardiac rehabilitation model of care in rural and remote areas of Australia. The goal of this model of care is to increase cardiac rehabilitation attendance and completion by country patients with cardiovascular diseases. We hypothesise that a model of care co-designed with stakeholders will address patients’ needs and preferences and increase participation. We applied the Model for Large Scale Knowledge Translation and engaged with patients, clinicians and health service managers across six local health networks in rural South Australia. They informed the design of a web-based cardiac rehabilitation programme and the delivery of the expanded telehealth service. The stakeholders defined face-to-face, telephone, web-based or combinations as choices of mode of delivery to patients referred to cardiac rehabilitation. A case-managed programme supported by a web portal with an interface for patients and clinicians was considered more appropriate to the local context than a self-managed programme. A business model was developed to enable the sustainability of cardiac rehabilitation clinical assessments through primary care. The impact of the model of care on cardiac rehabilitation attendance/completion, clinical outcomes, patient-reported outcomes and patient-reported experiences and cost-effectiveness will be tested in a 12-month follow-up study.

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Co-designing digital cardiac rehabilitation with patients living in rural and remote australia - the country heart attack prevention project

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.138 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

KATIE Nesbitt ◽

A Beleigoli ◽

H Du ◽

RA Clark ◽

R Tirimacco

Keyword(s):

Cardiac Rehabilitation ◽

Heart Attack ◽

Hospital Admissions ◽

Local Health ◽

Patient Portal ◽

Rural And Remote ◽

Cardiac Events ◽

Web Based ◽

System Usability Scale ◽

Prevention Project

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Co-sponsored National health Medical Partnership Grant OnBehalf the country heart attack prevention project Background/significance. Cardiac rehabilitation (CR) significantly reduces death, reoccurring cardiac events, hospital admissions while improving quality of life. However, it is still poorly attended with participation rates worldwide between 20-50%, worsened for rural and remote patients by the tyranny of distance, work responsibilities and transportation. Web-based CR can provide an alternative, patient centred, flexible delivery option. Co-design with consumers and clinicians is recommended to tailor web-based CR to their needs and preferences as a means of increasing attendance. Purpose. The objective of this study is to describe how patient-generated data through workshops on desired content and features informs technology and implementation specifications for the patient portal of a CR website. Methods. UX Design theoretical framework, using a co-design workshop, with thematic analysis, a survey, and the System Usability Scale was used to report outcomes. Results. Based on the feedback from participants in rural and remote SA, desired content and features were updated for improving user experience. We recruited 27 participants across 4 regional Local health Networks in SA. The median age of participants was 71.0 (IQR 58-78), 14 (51.9%) were female and 27 (100%) had completed a cardiac rehabilitation program. More than half used a smart phone (16; 59.3%) and Facebook (21; 77.8%). Overall usability remains low based on a mean SUS score of 63.4 (SD 21.1), however there was a tendency to usability improving over time. Conclusion. The co-design process has contributed to the development of the CR website, improving desired content and features. Improved usability scores can be achieved through further incorporating consumer feedback into the development of the CR website.

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Impact of a paediatric cardiac rehabilitation programme upon patient quality of life

Cardiology in the Young ◽

10.1017/s1047951120004710 ◽

2021 ◽

pp. 1-8

Author(s):

Kristin H. Kroll ◽

Joshua R. Kovach ◽

Salil Ginde ◽

Roni M. Jacobsen ◽

Michael Danduran ◽

...

Keyword(s):

Quality Of Life ◽

Cardiac Rehabilitation ◽

Exercise Capacity ◽

Psychosocial Functioning ◽

Rehabilitation Programme ◽

Self Concept ◽

Cardiac Rehabilitation Programme ◽

Patient Reported ◽

Related Quality

Abstract Introduction: Cardiac rehabilitation programmes for paediatric patients with congenital heart disease (CHD) have been shown to promote emotional and physical health without any associated adverse events. While prior studies have demonstrated the effectiveness of these types of interventions, there has been limited research into how the inclusion of psychological interventions as part of the programme impacts parent-reported and patient-reported quality of life. Materials and methods: Patients between the ages of 7 and 24 years with CHD completed a cardiac rehabilitation programme that followed a flexible structure of four in person-visits with various multidisciplinary team members, including paediatric psychologists. Changes in scores from the earliest to the latest session were assessed regarding exercise capacity, patient functioning (social, emotional, school, psychosocial), patient general and cardiac-related quality of life, patient self-concept, and patient behavioural/emotional problems. Results: From their baseline to final session, patients exhibited significant improvement in exercise capacity (p = 0.00009). Parents reported improvement in the patient’s emotional functioning, social functioning, school functioning, psychosocial functioning, cognitive functioning, communication, and overall quality of life. While patients did not report improvement in these above areas, they did report perceived improvement in certain aspects of cardiac-related quality of life and self-concept. Discussion: This paediatric cardiac rehabilitation programme, which included regular consultations with paediatric psychologists, was associated with divergent perceptions by parents and patients on improvement related to quality of life and other aspects of functioning despite improvement in exercise capacity. Further investigation is recommended to identify underlying factors associated with the differing perceptions of parents and patients.

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Dietary education provision within a cardiac rehabilitation programme in the UK: a pilot study

British Journal of Cardiac Nursing ◽

10.12968/bjca.2020.0012 ◽

2020 ◽

Vol 15 (8) ◽

pp. 1-12

Author(s):

Chelsea E Moore ◽

Costas Tsakirides ◽

Zoe Rutherford ◽

Michelle G Swainson ◽

Karen M Birch ◽

...

Keyword(s):

Physical Activity ◽

Cardiac Rehabilitation ◽

Rehabilitation Programme ◽

Habitual Physical Activity ◽

Activity Levels ◽

Nutrient Intakes ◽

Cardiac Rehabilitation Programme ◽

Physical Activity Levels ◽

Dietary Education ◽

The Impact

Background/aims The primary aim of this study was to evaluate the effectiveness of two 30-minute dietary education sessions, within cardiac rehabilitation, as a means to optimise nutrient and energy intakes. A secondary aim was to evaluate patients' habitual physical activity levels. Methods Thirty patients (males: n=24, 61.8±11.2 years; females: n=6, 66.7±8.5 years) attended a 6-week early outpatient cardiac rehabilitation programme in the UK and received two 30-minute dietary education sessions emphasising Mediterranean diet principles. Energy intakes and nutrient intakes were measured through completion of 3-day food diaries in weeks one and six (before and after the dietary education sessions) to assess the impact of these sessions on nutrient intakes. At the same time-points, a sub-group (n=13) of patients had their physical activity levels assessed via accelerometery to assess the impact of the cardiac rehabilitation programme on physical activity. Results Estimated energy requirements at week one (1988±366 kcal d−1) were not matched by actual energy intakes (1785±561 kcal d−1) (P=0.047, d=−0.36). Energy intakes reduced to 1655±470 kcal d−1 at week six (P=0.66, d=−0.33) whereas estimated energy requirements increased as a function of increased activity (cardiac rehabilitation sessions). Nutrient intakes remained suboptimal, while no significant increases were observed in healthy fats and fibre, which are core elements of a Mediterranean diet. Statistically significant increases were not observed in physical activity; however, patients decreased sedentary time by 11±12% in week six compared with week one (P=0.009; d=−0.54). Conclusions The present study findings suggest that two 30-minute dietary education sessions did not positively influence energy intakes and nutrient intakes, while habitual physical activity levels were not significantly increased as a result of the cardiac rehabilitation programme. Future research should explore means of optimising nutrition and habitual physical activity within UK cardiac rehabilitation.

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Exploring patient-reported outcomes of home-based cardiac rehabilitation in relation to Scottish, UK and European guidelines: an audit using qualitative methods

BMJ Open ◽

10.1136/bmjopen-2018-024499 ◽

2018 ◽

Vol 8 (12) ◽

pp. e024499 ◽

Cited By ~ 1

Author(s):

Hannah Ranaldi ◽

Carolyn Deighan ◽

Louise Taylor

Keyword(s):

Cardiac Rehabilitation ◽

Patient Reported Outcomes ◽

Psychosocial Support ◽

Daily Lives ◽

Medical Risk ◽

European Guidelines ◽

Home Based ◽

Patient Reported ◽

The Uk ◽

The Impact

ObjectivesThe Heart Manual (HM) is the UK’s leading facilitated home-based cardiac rehabilitation (CR) programme for individuals recovering from myocardial infarction and revascularisation. This audit explored patient-reported outcomes of home-based CR in relation to current Scottish, UK and European guidelines.SettingPatients across the UK returned their questionnaire after completing the HM programme to the HM Department (NHS Lothian).ParticipantsQualitative data from 457 questionnaires returned between 2011 and 2018 were included for thematic analysis. Seven themes were identified from the guidelines. This guided initial deductive coding and provided the basis for inductive subthemes to emerge.ResultsThemes included: (1) health behaviour change and modifiable risk reduction, (2) psychosocial support, (3) education, (4) social support, (5) medical risk management, (6) vocational rehabilitation and (7) long-term strategies and maintenance. Both (1) and (2) were reported as having the greatest impact on patients' daily lives. Subthemes for (1) included: guidance, engagement, awareness, consequences, attitude, no change and motivation. Psychosocial support comprised: stress management, pacing, relaxation, increased self-efficacy, validation, mental health and self-perception. This was followed by (3) and (4). Patients less frequently referred to (5), (6) and (7). Additional themes highlighted the impact of the HM programme and that patients attributed the greatest impact to a combination of all the above themes.ConclusionsThis audit highlighted the HM as comprehensive and inclusive of key elements proposed by Scottish, UK and EU guidelines. Patients reported this had a profound impact on their daily lives and proved advantageous for CR.

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Validity and test-retest reliability of a patient-reported outcome measure for an outpatient cardiac rehabilitation programme

British Journal of Cardiac Nursing ◽

10.12968/bjca.2018.0039 ◽

2019 ◽

Vol 14 (8) ◽

pp. 1-13

Author(s):

Aynsley Cowie ◽

Mario Hair ◽

Emma Kerr ◽

Janet McKay ◽

Lesley Allan ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Concurrent Validity ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Rehabilitation Programme ◽

Cardiac Rehabilitation Programme ◽

Retest Reliability ◽

Patient Reported Outcome Measure ◽

Patient Reported ◽

Test Retest Reliability

Background/Aims This article details how a patient-reported outcome measure (PROM), termed PROM-CR1, was tested for acceptability, validity and test-retest reliability at the end of an outpatient cardiac rehabilitation programme. Methods PROM-CR1 was completed by 138 service users (mean age 66.95 years, range 42–94 years; 115 males, 23 females; with a range of cardiac diagnoses), who used the tool at home twice: once at the end of the outpatient cardiac rehabilitation programme and 1 week later. Results PROM-CR1 demonstrated good acceptability, construct and concurrent validity, and test-retest reliability. The construct validity analysis highlighted that one item required removal from the PROM-CR1. Conclusions A finalised 30-item version of the tool will now be widely disseminated and further evaluated within cardiac rehabilitation clinical practice.

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The role of patient portals in enhancing self-care in patients with renal conditions

Clinical Kidney Journal ◽

10.1093/ckj/sfz154 ◽

2019 ◽

Vol 13 (1) ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Adil M Hazara ◽

Katherine Durrans ◽

Sunil Bhandari

Keyword(s):

Current Model ◽

Patient Empowerment ◽

Home Blood Pressure ◽

Test Results ◽

Model Of Care ◽

Patient Portals ◽

Web Based ◽

The Uk ◽

The Impact

Abstract Web-based portals enable patients to access their electronic health records, including test results and clinical documents, from anywhere with Internet access. Some portals also serve as a means of two-way communication between patients and healthcare professionals and provide a platform for the recording of patient-entered data such as home blood pressure readings. Such systems are designed to encourage patient participation in the management of their condition, and ultimately to increase patient empowerment and self-management, which are associated with improved clinical outcomes. As an example of portal use in patients with renal conditions, we discuss the PatientView portal, which is offered free of cost to patients under the care of renal physicians in the UK. We present an account of its various features and briefly describe the user experience. Previous studies examining the impact of this portal on patient care have been very positive; it appears to be popular among users and overall levels of satisfaction with the service are high. As the use of patient portals increases, we discuss barriers to the more widespread use of portals. We offer suggestions on how the care of patients with renal conditions can be enhanced in the future by further developing the existing features, learning from experiences of other patient portals and providing better integration of portal use into the current model of care.

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Web-Based Return of Individual Patient-Reported Outcome Results Among Patients With Lymphoma: A Randomized Controlled Trial (Preprint)

10.2196/preprints.27886 ◽

2021 ◽

Author(s):

Lindy Paulina Johanna Arts ◽

Simone Oerlemans ◽

Jacobien M Kieffer ◽

Judith Prins ◽

Mels Hoogendoorn ◽

...

Keyword(s):

Psychological Distress ◽

Breast Cancer Survivors ◽

Controlled Trial ◽

Patient Reported Outcome ◽

The Self ◽

Self Management ◽

Web Based ◽

Management Intervention ◽

Patient Reported ◽

The Impact

BACKGROUND There has been a cultural shift toward patient engagement in health with a growing demand from patients to access their results. OBJECTIVE The Lymphoma InterVEntion [LIVE] trial was conducted to examine the impact of return of individual patient-reported outcome (PRO) results and a web-based self-management intervention on psychological distress, self-management, and satisfaction with information in a population-based setting. METHODS Return of PRO results included comparison with age- and sex-matched peers and was built into the PROFILES registry. The self-management intervention is an adaptation of an fully-automated evidence-based intervention for breast cancer survivors. Patients with lymphoma who completed the web-based questionnaire were equally randomized to 1) care as usual (CAU), 2) return of PRO results, and 3) return of PRO results plus self-management intervention. Patients completed questionnaires 9 to 18 months after diagnosis (T0; n=227), after 4 months (T1; n=190), and after 12 months (T2; n=170). RESULTS Of all invited patients, 25% (227/892) were randomly assigned to CAU (n=76), return of PRO results (n=74), or return of PRO results and access to Living with lymphoma (n=77). Return of PRO results was viewed by 77% (115/150) of those with access. No significant differences were observed for psychological distress, self-management, satisfaction with information provision, and healthcare use between patients who received their PRO results and those who did not (P>.05). Usage of the self-management intervention was low (3%; 2/76) and an effect could therefore not be determined. CONCLUSIONS Return of individual PRO results seems to meet patients’ wishes, but had no beneficial effects on patient outcome. Also, no negative effects were found when individual PRO results were disclosed, and the return of individual PRO results can be safely implemented in daily clinical practice. CLINICALTRIAL Netherlands Trial Register NTR5953 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-017-1943-2

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Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment

Health Services and Delivery Research ◽

10.3310/hsdr02520 ◽

2014 ◽

Vol 2 (52) ◽

pp. 1-178 ◽

Cited By ~ 10

Author(s):

Céline Miani ◽

Sarah Ball ◽

Emma Pitchforth ◽

Josephine Exley ◽

Sarah King ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Evidence Synthesis ◽

Grey Literature ◽

Length Of Hospital Stay ◽

Theory Of Change ◽

Local Context ◽

Health Economy ◽

Local Health ◽

The Impact

BackgroundAvailable evidence on effective interventions to reduce length of stay in hospital is wide-ranging and complex, with underlying factors including those acting at the health system, organisational and patient levels, and the interface between these. There is a need to better understand the diverse literature on reducing the length of hospital stay.ObjectivesThis study sought to (i) describe the nature of interventions that have been used to reduce length of stay in acute care hospitals; (ii) identify the factors that are known to influence length of stay; and (iii) assess the impact of interventions on patient outcomes, service outcomes and costs.Data sourcesWe searched MEDLINE (Ovid), EMBASE, the Health Management Information Consortium and System for Information on Grey Literature in Europe for the period January 1995 to January 2013 with no limitation of publication type.MethodsWe conducted a rapid evidence synthesis of the peer-reviewed literature on organisational interventions set in or initiated from acute hospitals. We considered evidence published between 2003 and 2013. Data were analysed drawing on the principles of narrative synthesis. We also carried out interviews with eight NHS managers and clinical leads in four sites in England.ResultsA total of 53 studies met our inclusion criteria, including 19 systematic reviews and 34 primary studies. Although the overall evidence base was varied and frequently lacked a robust study design, we identified a range of interventions that showed potential to reduce length of stay. These were multidisciplinary team working, for example some forms of organised stroke care; improved discharge planning; early supported discharge programmes; and care pathways. Nursing-led inpatient units were associated with improved outcomes but, if anything, increased length of stay. Factors influencing the impact of interventions on length of stay included contextual factors and the population targeted. The evidence was mixed with regard to the extent to which interventions seeking to reduce length of stay were associated with cost savings.LimitationsWe only considered assessments of interventions which provided a quantitative estimate of the impact of the given organisational intervention on length of hospital stay. There was a general lack of robust evidence and poor reporting, weakening the conclusions that can be drawn from the review.ConclusionsThe design and implementation of an intervention seeking to reduce (directly or indirectly) the length of stay in hospital should be informed by local context and needs. This involves understanding how the intervention is seeking to change processes and behaviours that are anticipated, based on the available evidence, to achieve desired outcomes (‘theory of change’). It will also involve assessing the organisational structures and processes that will need to be put in place to ensure that staff who are expected to deliver the intervention are appropriately prepared and supported. With regard to future research, greater attention should be given to the theoretical underpinning of the design, implementation and evaluation of interventions or programmes. There is a need for further research using appropriate methodology to assess the effectiveness of different types of interventions in different settings. Different evaluation approaches may be useful, and closer relationships between researchers and NHS organisations would enable more formative evaluation. Full economic costing should be undertaken where possible, including considering the cost implications for the wider local health economy.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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How the COVID pandemic affected utilisation of cardiac rehabilitation in rural Australia?

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.070 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

A Beleigoli ◽

S Champion ◽

R Tirimacco ◽

K Govin ◽

P Tideman ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

South Australia ◽

Adverse Outcomes ◽

Public Institution ◽

World Health ◽

Economic Disadvantage ◽

Local Health ◽

Service Access ◽

Rural And Remote ◽

Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Caring Futures Institute Background Provision of cardiac rehabilitation (CR) was disrupted in 31% of the 155 countries according to the World Health Organisation during the early months of the COVID pandemic. This might have been associated with worsening clinical outcomes and is of particular concern to patients living in rural and remote areas. In Australia, these patients have a higher prevalence of cardiovascular diseases, higher rates of adverse outcomes due to acute myocardial infarction and limited availability to regional services. Purpose We aimed to investigate how the COVID affected the delivery of CR services in rural and remote South Australia (SA) during the first wave of the COVID pandemic. Methods CR attendance, completion and waiting times in the pre-COVID period (February-July 2019) was compared to data during the first wave of COVID (February-July 2020) using data from CR services across six regional local health networks recorded in the Country Access to Cardiac Health (CATCH) database. Results There were 922 patients (32.2% females; mean age 69.2 years; 36.6% living in areas with high socio-economic disadvantage) referred to CR in the pre-COVID period, and 1032 patients (30.7% females; mean age 68.1 years; 35.7% living in areas with high socio-economic disadvantage) in the COVID period across the six regional areas in South Australia. Acute coronary syndrome was the main reason for referral both pre (251; 27.2%) and during COVID (273; 26.5%). The proportion of CR attendance was higher in the pre (522; 56.6%) compared to the COVID period (431, 41.8%; p < 0.001). Completion was higher pre (413, 79.1%) compared to during COVID period (205,47.6%) completed CR during the COVID period (p < 0.001). The waiting time was 35 (SD 27) days pre-COVID and 34 (SD 25) days in the COVID period (p = 0.37). Conclusion Our data show that attendance and completion of CR programs were significantly reduced during the COVID period in rural and remote Australia. Limited service access during the pandemic and fear to physically attend health services during the period of social and physical restrictions might have contributed to this. Telehealth-delivered CR can provide opportunities to continuity of cardiovascular care and secondary prevention during pandemic restrictions.

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Negligible Effects of the Survey Modes for Patient-Reported Outcomes: A Report From the Childhood Cancer Survivor Study

JCO Clinical Cancer Informatics ◽

10.1200/cci.19.00135 ◽

2020 ◽

pp. 10-24

Author(s):

Jin-ah Sim ◽

Geehong Hyun ◽

Todd M. Gibson ◽

Yutaka Yasui ◽

Wendy Leisenring ◽

...

Keyword(s):

Childhood Cancer ◽

Measurement Properties ◽

Web Based ◽

Scale Reliability ◽

Patient Reported ◽

Childhood Cancer Survivor Study ◽

Survivors Of Childhood Cancer ◽

Anxiety Depression ◽

The Impact ◽

Postal Mail

PURPOSE This study compared the measurement properties for multiple modes of survey administration, including postal mail, telephone interview, and Web-based completion of patient-reported outcomes (PROs) among survivors of childhood cancer. METHODS The population included 6,974 adult survivors of childhood cancer in the Childhood Cancer Survivor Study who completed the Brief Symptom Inventory-18 (BSI-18), which measured anxiety, depression, and somatization symptoms. Scale reliability, construct validity, and known-groups validity related to health status were tested for each mode of completion. The multiple indicators and multiple causes technique was used to identify differential item functioning (DIF) for the BSI-18 items that responded through a specific survey mode. The impact of the administration mode was tested by comparing differences in BSI-18 scores between the modes accounting for DIF effects. RESULTS Of the respondents, 58%, 27%, and 15% completed postal mail, Web-based, and telephone surveys, respectively. Survivors who were male; had lower education, lower household income, or poorer health status; or were treated with cranial radiotherapy were more likely to complete a telephone-based survey compared with either a postal mail or Web-based survey (all P < .05). Scale reliability and validity were equivalent across the 3 survey options. One, 2, and 5 items from the anxiety, depression, and somatization domains, respectively, were identified as having significant DIF among survivors who responded by telephone ( P < .05). However, estimated BSI-18 domain scores, especially depression and anxiety, between modes did not differ after accounting for DIF effects. CONCLUSION Certain survivor characteristics were associated with choosing a specific mode for PRO survey completion. However, measurement properties among these modes were equivalent, and the impact of using a specific mode on scores was minimal.

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