None listed
Conditions
Brief summary
Cardiovascular disease (CVD) is the most common cause of morbidity and premature death worldwide. It is projected that the number of fatalities related to CVD will increase to more than 24 million annually by 2030. In Australia, 1 in every 5 adults had CVD based on self-reported data, and 11% of all hospitalizations are caused by this deadly disease. The growing epidemic of CVD has resulted in calls for a universal model of care to provide rehabilitative and preventive services for all patients with this disease. Cardiac rehabilitation/secondary prevention programs (CR/SPPs) are medically supervised programs that help patients with CVD to recover more quickly after a cardiac event and to stay healthy. CR/SPPs have been shown to reduce readmission and mortality. However, despite the accumulating evidence and potential benefits, less than 30% of eligible patients participated in CR/SPPs. The aim of this project is to assess the current status of CR/SP services at Fiona Stanley Hospital (FSH), identify strengths and limitations of the CR/SP program and to develop and implement strategies for improvement of services. This will involve review of previous data from medical records relating to the CR/SP program and a continuous quality improvement approach to refine services in accordance with international best practice. The project will use a mixed methods research approach. First, an audit of medical records will be performed to objectively quantify CR/SP referral, attendance and completion rates amongst acute coronary syndrome (ACS) patients at FSH. Second, stakeholder surveys, focus group discussions and face-to-face interviews will be conducted to investigate barriers and facilitators to CR/SP service provision. For this second stage, current patients will be asked to complete a survey (and some to attend focus groups) and Cardiology Ward staff will be invited to complete a survey (and some attend individual interviews with the researchers). This information will be used to guide changes to CR/SP systems with the objective of increasing the number of patients receiving the core components of CR/SP program: assessment, nutritional counseling, aggressive risk factor management (ie, lipids, hypertension, weight, diabetes mellitus, and smoking), psychosocial and vocational counseling, and physical activity counseling and exercise training. Study summary 1. Audit: Two six-month audit cycles of consecutively admitted ACS patients will be conducted (for the six month periods beginning 1 January 2016 and 2017 respectively) with CR/SP program performance improvement strategies developed and implemented in between; 2. Patient and staff surveys: 100 ACS patients and 50 staff who work on the cardiology ward will be recruited to participate in the second part of the study with the completion of a survey; 3. Focus group discussions and interviews: Subsequent to the surveys, 30 patient participants and 10 staff participants will be invited to take part in focus group discussions and face-to-face interviews respectively. The responses from the surveys will be evaluated to establish common themes and to guide discussions in the focus groups. Although the project at FSH is an independent process monitoring and quality improvement initiative, it is also a key component of a larger project that aims to develop culturally appropriate CR/SP models for two mainland Chinese populations.
Interventions
1. Based on data collected from the first cycle of clinical audit, as well as surveys and group discussions, quality improvement initiatives will be developed and implanted. This may include redesigning the cardiac rehabilitation referral system, improving patient education program, developing advocacy programs for cardiac rehabilitation and secondary prevention among patients and staff, developing alternative models of cardiac rehabilitation and secondary prevention etc.
2. After the first cy
1. Based on data collected from the first cycle of clinical audit, as well as surveys and group discussions, quality improvement initiatives will be developed and implanted. This may include redesigning the cardiac rehabilitation referral system, improving patient education program, developing advocacy programs for cardiac rehabilitation and secondary prevention among patients and staff, developing alternative models of cardiac rehabilitation and secondary prevention etc. 2. After the first cycle of clinical audit, current ACS patients will be asked to complete a survey (and some to attend focus groups) and Cardiology Ward staff will be invited to complete a survey (and some attend individual interviews with the researchers). 3. Quality improvement initiatives will be developed and implanted between the two audit cycles within a period of 6 months. The effectiveness of the initiatives will be evaluated through the second cycle of clinical audit.
Sponsors
Curtin University
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Clinical Audit: All patients admitted at FSH with a diagnosis of ACS during the two cycles of audit (for the six month periods beginning 1 January 2016 and 2017 respectively) will be included in the Audit. Patient Survey: Current patients admitted to FSH with an ACS during the strudy period. Staff Survey: Currently employed staff who working at cardiology department of FSH as a care giver providing cardiology service to both outpatient and inpatient are eligible to participate the study. Patient Focus Groups & Staff Interviews: One in four of the patients who returned surveys will be randomly selected and contacted by a phone call from the research team to take part in focus group discussions. Similarly, staff will be randomly selected to take part in face-to-face interviews subsequent to the surveys since it is unlikely to be possible to arrange a group discussion for medical/health staff in a busy clinical setting.
Exclusion criteria
Hospitality mortality data will be reviewed and invitation letters or phone calls for participating the survey and focus group discussion will not be sent to the addresses of deceased patients.
Outcome results
None listed