Abstract
PURPOSE: The measurement of outpatient cardiac rehabilitation (OCR) outcomes is now considered common practice. Unfortunately, because of the costs involved in purchasing outcomes tracking software, many programs are not able to participate in pooled outcomes analysis and benchmarking. The purpose of this report is to describe the current OCR outcomes data in the state of Wisconsin using a web-based model for outcomes data collection, data pooling, and benchmarking.
METHODS: Participating OCR programs collected individual patient outcomes according to protocols developed by the Wisconsin Society for Cardiovascular and Pulmonary Rehabilitation's Outcomes Committee. Programs analyzed their data quarterly and submitted the values to a database via an Internet web site. Aggregate outcomes data from 34 programs were collected over a 27-month period.
RESULTS: Aggregate data representing 5235 OCR patients are presented. The mean age for the men was 64 +/- 5 years (N = 3612; 69% of the sample). The mean age for the women was 67 +/- 6 years (N = 1623; 31% of the sample). The completion rate for the group was 89% (95%CI, 86-91). The average number of OCR sessions per patient was 22 +/- 6 over 9 +/- 3 weeks. The clinical and behavioral outcomes for this sample ranged from a median value of 88% for the percentage of patients meeting the blood pressure goal (95%CI, 87-91) to less than 5% for the percentage of patients receiving formal psychosocial counseling (95%CI, 0). The major cardiovascular event rate was 0.17 per 10,000 patient-hours.
CONCLUSION: This report describes the baseline OCR outcomes obtained via a state affiliate-sponsored outcomes management program. These data show that this model of OCR outcomes measurement, collection, and interprogram analysis produces data that are comparable with those of published, controlled studies. Determining baseline characteristics of OCR outcomes data will be important in the development of benchmarks and best practice guidelines.
In 1995, the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR) Outcomes Committee published their landmark position statement regarding the value and rationale of outcomes measurement. 1 This article laid the groundwork for the development of systems to measure objectively the outcomes of patients receiving outpatient cardiac rehabilitation (OCR).
Two years later, AACVPR asked affiliate societies for feedback from member programs regarding methods used to collect OCR outcomes. The Wisconsin Society for Cardiovascular and Pulmonary Rehabilitation (WISCVPR) sent a survey to the state's programs, asking whether they collected outcome data, and if so, how the data were collected. The results indicated that although 81% of the responding programs were collecting outcomes, few (33%) actually were analyzing their data. This probably reflected the fact that only 8% were using computerized methods for data collection. Presumably, computerized processes would make outcomes analysis easier. At the time, however, commercial outcomes tracking software was beyond the means of most programs, nor did they have the expertise to create their own custom outcomes applications.
Recognizing that the Internet could be a useful tool in helping programs track OCR outcomes, the author proposed the WISCVPR Web-based Outcomes Project (W2eBOP). It was intended to assist programs in the measurement and analysis of short-term OCR and follow-up outcomes. Other AACVPR-affiliated state societies, most notably North Carolina and Indiana, had organized large-scale OCR outcomes projects, but none had initially used the Internet for submission of data or instantaneous comparative report generation, and most of these projects were for a limited time.
Regardless of the tools used to gather outcomes data, it is necessary to describe the current practice patterns and outcomes of OCR programs before best practice guidelines and benchmarks can be established. A baseline must be established from which improved outcomes, or conversely, worse outcomes, can be measured. Therefore, in this report reviews the results from more than 2 years of OCR outcomes data to establish a baseline performance of OCR programs.