[Method of the assessment of patients outcome in cardiac rehabilitation by means of quality indicators--a description of the method].
BACKGROUND
Cardiac rehabilitation is designed for patients suffering from cardiovascular diseases or functional disabilities. The aim of a cardiac rehabilitation is to improve overall physical health, psychological well-being, physical function, the ability to participate in social life and help patients to change their habits. Regarding the heterogeneity of these aims measuring of the effect of cardiac rehabilitation is still a challenge. This study recommends a concept to assess the effects of cardiac rehabilitation regarding the individual change of relevant quality indicators.


METHODS
With "EVA-Reha; cardiac rehabilitation" the Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey (MDK Rheinland-Pfalz) developed a software to collect data set including sociodemographic and diagnostic data and also the results of specific assessments. The project was funded by the Techniker Krankenkasse, Hamburg, and supported by participating rehabilitation centers. From 01. July 2010 to 30. June 2011 1309 patients (age 71.5 years, 76.1% men) from 13 rehabilitation centers were consecutively enrolled. 13 quality indicators in 3 scales were developed for evaluation of cardiac rehabilitation: 1) cardiovascular risk factors (blood pressure, LDL cholesterol, triglycerides), 2) exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure [NYHA classification], and angina pectoris [CCS classification]) and 3) subjective health (IRES-24: pain, somatic health, psychological wellbeing and depression as well as anxiety on the HADS). The study was prospective; data of patients were assessed at entry and discharge of rehabilitation. To measure the success of rehabilitation each parameter was graded in severity classes at entry and discharge. For each of the 13 quality indicators changes of severity class were rated in a rating matrix. For indicators without a requirement for medical care neither at entry nor at discharge no rating was performed.


RESULTS
The grading into severity classes as well as the minimal important differences were given for the 13 quality indicators. The result of rehabilitation can be demonstrated in suitable form by means of rating of the 13 quality indicators according to a clinical population. The rating model differs well between clinically changed and unchanged patients for the quality indicators.


CONCLUSIONS
The result of cardiac rehabilitation can be assessed with 13 quality indicators measured at entry and dis­charge of the rehabilitation program. If a change into a more ­favorable category at the end of rehabilitation could be achieved it was counted as a success. The 13 quality indicators can be used to assess the individual result as well as the result of a population--e. g. all patients of a clinic in a specific time period. In addition, the assessment and rating of relevant quality indicators can be used for comparisons of rehabilitation centers.
Medizinischer Dienst der Krankenversicherung Rheinland-Pfalz, Alzey.
B
B
Röhrig
Medizinischer Dienst der Krankenversicherung Rheinland-Pfalz, Alzey.
M
M
Nosper
Medizinischer Dienst der Krankenversicherung Rheinland-Pfalz, Alzey.
S
S
Linck-Eleftheriadis
Techniker Krankenkasse Hamburg.
G
G
Strandt
Institut für Klinische Pharmakologie und Toxikologie, Charité (CBF) Berlin.
A
A
Salzwedel
Institut für Klinische Pharmakologie und Toxikologie, Charité (CBF) Berlin.
H
H
Völler
D000368:Aged; D000465:Algorithms; D005260:Female; D005858:Germany; D006331:Heart Diseases / Q000175:diagnosis* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards*; D063868:Patient Outcome Assessment; D019984:Quality Indicators, Health Care / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index