Quality indicators for cardiac rehabilitation after myocardial infarction in China: a consensus panel and practice test

Xianghui Zheng, Maomao Zhang, Yang Zheng, Yongxiang Zhang, Junnan Wang, Ping Zhang, Xuwen Yang, Shan Li, Rongjing Ding, Gaowa Siqin, Xinyu Hou, Liangqi Chen, Min Zhang, Yong Sun, Jian Wu, Bo Yu, Xianghui Zheng, Maomao Zhang, Yang Zheng, Yongxiang Zhang, Junnan Wang, Ping Zhang, Xuwen Yang, Shan Li, Rongjing Ding, Gaowa Siqin, Xinyu Hou, Liangqi Chen, Min Zhang, Yong Sun, Jian Wu, Bo Yu

Abstract

Objectives: Cardiac rehabilitation (CR) improves outcomes after myocardial infarction (MI), but it is underused in China. The purpose of this study was to develop a set of quality indicators (QIs) to improve clinical practices and to confirm the measurability and performance of the developed QIs for CR in Chinese patients after MI.

Design and setting: The QIs were developed by a Chinese expert consensus panel during in-person meetings. The five QIs most in need of improvement were selected using a national questionnaire. Finally, the completion rate and feasibility of the QIs were verified in a group of MI survivors at university hospitals in China.

Participants: Seventeen professionals participated in the consensus panel, 89 personnel in the field of CR participated in the national questionnaire and 165 MI survivors participated in the practice test.

Results: A review of 17 eligible articles generated 26 potential QIs, among which 17 were selected by the consensus panel after careful evaluation. The 17 QIs were divided into two domains: (1) improving participation and adherence and (2) CR process standardisation. Nationwide telephone and WeChat surveys identified the five QIs most in need of improvement. A multicenter practice test (n=165) revealed that the mean performance value of the proposed QIs was 43.9% (9.9%-86.1%) according to patients with post-MI.

Conclusions: The consensus panel identified a comprehensive set of QIs for CR in patients with post-MI. A nationwide questionnaire survey was used to identify the QIs that need immediate attention to improve the quality of CR. Although practice tests confirmed the measurability of the proposed QIs in clinical practice, the implementation of the QIs needs to be improved.

Trial registration number: This study is part of a study registered in ClinicalTrials.gov (NCT03528382).

Keywords: coronary heart disease; myocardial infarction; rehabilitation medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Mean of all the indicators identified by the consensus panel. (A) The mean of domain 1: improving CR participation and adherence. (B) The mean of domain 2: CR process standardisation. CR, cardiac rehabilitation.
Figure 2
Figure 2
Regional distributions of the national questionnaire. Blue represents the areas surveyed, while white represents areas not surveyed.
Figure 3
Figure 3
Quality indicators from the national questionnaires that were identified as needing immediate improvement (blue). (A) Domain 1: improving CR participation and adherence. (B) Domain 2: CR process standardization.

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