Identifying and addressing barriers and enablers to implementing best-practice cardiac rehabilitation: the Quality Improvement in Cardiac Rehabilitation (QUICR) Cluster-Randomised Controlled Trial

CR program sites allocated to the intervention arm will receive a multicomponent intervention package, including: 1. Data Dashboard and Monthly Reports CR program sites will enter patient data into the REDCap data collection platform and will be provided with monthly reports summarising this data for each quality indicator assessed. Quality indicators include comprehensive assessment, depression screening, smoking assessment, assessment of medication adherence, exercise capacity, health related quality of life, and wait time to enrolment. Data from REDCap will automatically be transferred into a dashboard, which generates reports that will be provided to intervention sites every month. CR sites will have a designated identifying number. The monthly report will include the site’s own data as well as the aggregate data of all other sites. Interpretation of monthly reporting will be facilitated by a research team member with discussion about quality improvement progress. A monthly audit of the data on REDCap will be done monthly by the research team. 2. Collaborative Quality Improvement CR program site leaders will be supported to develop quality improvement skills using the Plan-Do-Study-Act (PDSA) method. Regular group-based workshops (n=4) (1 in-person and 3 online) will be held to assist expert clinicians use data to identify and initiate practice changes to improve patient completion that could be implemented and tested iteratively over time. The initial group-based workshop will be all-day (6-hours) and in-person for all intervention participants within three months of beginning data entry. Workshop dates will be coordinated to minimise work disruption and CR site representatives’ travel costs (air fares, fuel, taxis, and accommodation, if needed) will be covered and organised by the research team. Following the initial workshop, all workshops will be online, 2-3 hours in duration and occur every second month. The individual CR program site data reports will be discussed during the workshops and the collated reports used to identify collaborative areas for improvement and find and test potential solutions to common problems. There will be a focus on PDSA for CR program completion included in all workshops and reports. The collaborative approach will promote mutual learning among sites in addressing shared issues. The workshops will be facilitated by research team members with expertise, skills, and prior experiences in collaborative quality improvement. Cardiac rehabilitation staff (registered nurses, exercise physiologists, cardiac rehabilitation coordinators, cardiac rehabilitation managers) are eligible to attend the workshops. A minimum of one staff member per site will be required to attend the workshops over the 12 month period of the study. The workshops will be delivered both in person and virtually to accomodate participation of all study site coordinators. 3. Facilitation and Support Aside from individual facilitated monthly reports and discussion with CR program sites. All participating intervention group CR program site staff will have access to a SharePoint site as repository for resources, for example, documents on how to write a PDSA statement, interpreting the monthly reports, and the contact details of the research team to discuss issues during business hours for the entire study duration. These support channels will ensure closer adherence to the PDSA method and the collaborative goals, as well as the opportunity to clarify queries with the research team. Participants are required to access the monthly data reports via Sharepoint once generated throughout the 12 month period. Sharepoint analytics will be used to monitor engagement of cardiac rehabilitation coordinators and staff members. Personalised check ins with all sites allocated to the intervention group will be provided throughout the 12 month period to ensure they understand the data reports.