W2eBOP Consensus Paper—A Supporting Statement by the WISCVPR Outcomes Committee

Committee Members: Barbra Fagan, M.S. (Chair), Menomonee Falls; Kim Beyer, M.S. Milwaukee; Tracy Herrewig, M.S., Beaver Dam; Kelly Shields, M.S., Stevens Point; Charlie Steil, M.S., Eau Claire; Carolyn Verhage, R.N., Sheboygan; Mark Vitcenda, M.S., Madison; Lisa Wenzel, M.S., Madison.

Issue

Measuring outcomes is recognized as an essential component in the evaluation of the effectiveness of cardiac rehabilitation programs. An outcome is the end result of a process. In cardiac rehabilitation, it is the measure of a patient’s progress toward a defined goal. Outcomes are also data collected to demonstrate the efficacy of a program’s procedures. This is an important aspect of any program in order to justify the value of the program’s services both clinically and financially. In the changing health care environment, every program will be accountable for their costs and their processes. Therefore, the movement by cardiac rehabilitation professionals to measure outcomes is a proactive commitment to high standards and quality programs.

Resources

The Wisconsin Web-Based Outcomes Project Committee (W2eBOP), with support of AACVPR and WISCVPR, was formed to address and develop a standardized set of cardiac rehabilitation outcome measures. The Committee is a representation of various regions within the state of Wisconsin as well as diverse program sizes and experiences.

The Committee determined a general need to focus on collecting data and to move from general, nonspecific outcome measures to more specific, patient-oriented measures that are able to be standardized for benchmarking purposes. To this end, the Committee sent a questionnaire to state members to examine what outcomes are currently being measured and what members felt were important aspects to be measured.

Implementation Plan

From the results of the survey, the Committee selected outcomes based on several criteria:

  • Is the measure clinically relevant and meaningful?
  • Is the measure easily obtained through current practices?
  • Is the measure controllable?
  • Does the outcome have the potential to be improved?
  • Is the measure reproducible?
  • Can the measure be compared between programs of varying sizes and resources?

The Committee followed outcome guidelines established by AACVPR. Four main domains were chosen: clinical, behavioral, health and economic (See Table 1).

The Committee also recognized the importance of following patients after discharge from Phase 2 rehabilitation. A set of specific follow-up measures, based on Phase 2 outcomes, was therefore developed to measure long-term changes in patient outcomes. Lastly, it was felt that the measures should permit flexibility in allowing programs to determine individual program goals while maintaining some standardization within the state. The final set of measures was reviewed by the Committee and sent to the WISCVPR Board of Directors. The project gained the endorsement of the Board in October, 1999.

Goals/Benefits

These measures are NOT guidelines for individual patient care, or minimal or maximal standards of care, but should be considered performance measures that allow programs to compare over time their specific patient populations versus state benchmarks. These measures should be recognized as an initial attempt at standardizing basic cardiac rehabilitation outcome measures for the state of Wisconsin. There may be changes to the measures as more experience is gained. The Committee will assess the data, review the project and report its progress to the WISCVPR Board of Directors in 2000.

WISCVPR realized the necessity of gathering outcomes consistently using standardized documentation. After extensive consideration and deliberation, the W2eBOP Committee developed an electronic format to facilitate this process by using the Internet. Data will be entered on the WISCVPR web-site and immediate feedback will be generated through printable reports. The measures will be reported as aggregate data (percent of sample meeting outcome criterion or average change in a measure) comparing entry and discharge, or in the case of follow-up data, comparing follow-up and discharge.

Summary

In summary, the W2eBOP Committee is committed to taking a proactive approach to measuring outcomes and benchmarking program efficiency throughout the state of Wisconsin. A statewide database is expected to positively impact cardiac rehabilitation through its flexibility and instant report generation. It is hoped that all cardiac rehabilitation programs in the state, depending on their abilities and resources, will take part at some level in this process.

Table 1: W2eBOP Cardiac Rehabilitation Outcome Domains

Clinical

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Behavioral

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Health

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Economic

  • Functional
  • Blood Pressure Management
  • Lipid Management
/
  • Smoking Cessation
  • Diet Management
  • Psychosocial
  • Exercise Habits
  • Lifestyle Behavior Compliance
/
  • Quality of Life
/
  • Medical care usage
  • Events
  • Financial