[Developing an evidence based clinical guideline on cardiac rehabilitation--Phase 2: comparative analysis of the present level of service provision in cardiac rehabilitation based on the KTL statistics].
BACKGROUND
This project aims to develop an evidence based clinical guideline for the rehabilitation of cardiac patients considering recent scientific literature (stage 1), procedures received by cardiac patients undergoing rehabilitation carried by the German Federal Insurance Institute for Salaried Employees (BfA) based on the Classification of Therapeutic Procedures (KTL) (stage 2), and expert agreement of the professionals involved (stage 3). This study presents the results of stage 2. The analysis of the KTL-statistics was carried out to determine whether it is essentially necessary to implement a guideline and to define "critical" aspects, i. e. aspects that require high priority implementation. The project is part of a research programme funded by the BfA.


METHODS
317 out of the 840 possible KTL-codes were attributed to one of twelve therapeutic modules that--according to the results of stage 1--are characteristics of cardiac rehabilitation. For these modules the number of people having received therapeutic procedures belonging to the respective module the duration per patient and per week were calculated. The influence of concomitant factors such as age, gender and indication were analysed multivariately. Furthermore, the hospitals involved were compared. The analyses are based on approximately 87,400 KTL-entries from 5,494 patients (indication: "myocardial infarction" or "coronary artery bypass surgery") treated in 2000.


RESULTS
On average the patients receive therapeutic procedures "stemming" from 5.5 modules. More than 90 % receive procedures assigned to the modules "endurance training" or "motivation", respectively, and almost 70 % from "nutrition training". The other modules are rendered not consistently and occasionally to a relatively small degree. Younger patients following a myocardial infarction receive therapeutic procedures more frequently and longer while older patients after bypass surgery are treated less frequently and for a shorter duration. There is substantial variability between individual clinics.


CONCLUSIONS
It appears to be necessary to implement clinical practice guidelines in all evaluated therapeutic modules but "endurance training" and "motivation". An evidence based clinical practice guideline for the rehabilitation of cardiac patients should detail the kind and extent of procedure(s) required. It should also inform about the lack of evidence for variations in treatment with respect to age, gender, or indication. To facilitate monitoring of the degree of implementation of the guideline precise instructions for the documentation using the KTL should be developed and implemented. As a next step towards an evidence based, empirically proven and acceptable guideline this project's results will be discussed with experts from science and clinical practice.
Bitzer
E M
EM
Institut für Sozialmedizin, Epidemiologie und Gesundheitssystemforschung, Hannover. bitzer@iseg.de
Klosterhuis
H
H
Dörning
H
H
Rose
S
S
D003131:Combined Modality Therapy / Q000592:standards; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D003376:Counseling / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards; D015444:Exercise; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009203:Myocardial Infarction / Q000534:rehabilitation*; D009313:National Health Programs / Q000592:standards*; D010348:Patient Care Team / Q000592:standards; D010353:Patient Education as Topic / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D017064:Process Assessment, Health Care
Entwicklung einer evidenzbasierten Leitlinie zur kardiologischen Rehabilitation--Phase 2: Vergleichende Analyse des Ist-Zustandes der in der kardiologischen Rehabilitation erbrachten Leistungen auf der Basis der KTL-Statistik.