title: Evaluation of the recommended core components of cardiac rehabilitation practice: an opportunity for quality improvement.
abstract: OBJECTIVE
  Guidelines have been established that describe recommended core components for cardiac rehabilitation (CR) programs; yet, there are no national efforts to monitor the integration of the guidelines. The purpose of this research was to describe incorporation of core components in CR programs.
  
  
  METHODS
  This was a cross-sectional study using the Ohio Phase II Cardiac Rehabilitation Survey. Descriptive analyses were stratified on American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) certification, case management, and staff mix.
  
  
  RESULTS
  Sixty-six percent (n = 94) of programs responded, 39% (n = 37) were AACVPR certified, 40% (n = 38) used case management, and 73% (n = 75) staffed an exercise physiologist. Notable findings included that only 44% of programs obtained/performed a 12-lead electrocardiogram and 36% screened for depression. AACVPR-certified programs compared with uncertified programs were more likely to manage overweight/obesity (100% vs 84% instruct on weight control, respectively, P = .02) and perform health assessments upon admission (89% vs 70% respectively, P = .04). Programs using case management when compared with programs that did not use case management were more likely to administer a health survey (92% vs 65%, respectively, P = .003) and risk stratify (100% vs 84%, respectively, P = .02). Programs with an exercise physiologist were more likely to administer/obtain a stress test when compared with those without an exercise physiologist (78% vs 56%, respectively, P = .04).
  
  
  CONCLUSIONS
  There was a lack of consistency in the incorporation of core component guidelines; certification, case management, and staff mix offered little improvement. This study provides direction for statewide quality improvement initiatives to improve care delivered in CR programs.
authors.affiliation: Division of Epidemiology, College of Public Health at Kent State University, Kent, Ohio 44242, USA. mellenbu@kent.edu
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Zullo
authors.forename: Leila W
authors.initials: LW
authors.lastname: Jackson
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
authors.forename: Mary A
authors.initials: MA
authors.lastname: Dolansky
mesh_terms: D019090:Case Management; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000517:prevention & control* / Q000534:rehabilitation; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D017079:Exercise Tolerance; D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D009043:Motor Activity; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D013223:Statistics as Topic