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Updated: Jun 23, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Data-driven collaborative QUality improvement in Cardiac Rehabilitation (QUICR) to increase program completion:
Dion Candelaria1, Julie Redfern2, Adrienne O'Neil3
1Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia. dion.candelaria@sydney.edu.au.
Insights
This study investigates a quality improvement intervention to boost cardiac rehabilitation (CR) completion rates for coronary heart disease (CHD) patients. The goal is to improve patient outcomes and healthcare efficiency through data-driven strategies.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Coronary heart disease (CHD) is a leading global cause of mortality and morbidity.
- Cardiac rehabilitation (CR) is crucial for secondary prevention in CHD patients but suffers from low completion rates.
- Variable CR program quality and data systems hinder effective patient care and outcomes.
Purpose of the Study:
- To evaluate a data-driven collaborative quality improvement intervention for CR programs.
- To determine if the intervention increases CR program completion rates in CHD patients.
- To assess the intervention's impact on hospital admissions, emergency visits, mortality, costs, and adherence to CR guidelines.
Main Methods:
- A multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT).
- 40 CR programs and approximately 2,000 patients randomized to intervention (data-driven quality improvement) or control (usual care).
- 12-month follow-up with intention-to-treat analysis using mixed-effects models.
Main Results:
- The study aims to detect a 22% difference in CR completion rates.
- Secondary outcomes include reductions in hospital admissions, emergency department presentations, deaths, and costs.
- The intervention's feasibility, sustainability, and impact on guideline adherence will be assessed.
Conclusions:
- Innovative strategies are needed to address low CR participation in CHD patients.
- This trial will leverage collaborative efforts and local data to enhance CR program performance.
- Data linkage will efficiently evaluate the intervention and improve health service delivery.
Background:
Coronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely.
Methods:
QUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes.
Discussion:
Addressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery.
Ethics:
Primary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals.
Trial Registration:
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true ).
