Outpatient cardiac rehabilitation. Retrospective cohort study (with/without phase III rehabilitation) - Part IIIa + IIIb

Research area: Rehabilitation and occupational therapy

Michael Gyimesi
Duration: Oktober 2008 - 2010

Suggested by: HVB
Publication: HTA project report 15 (Part 1+2/2008): https://eprints.aihta.at/800/

Outpatient cardiac rehabilitation
Part IIIa: Retrospective cohort study (with/without phase III rehabilitation - Explorative analysis and developing of an evaluation plan (HTA Project report No. 31a)
Part IIIb: Retrospective cohort study (with/without phase III rehabilitation - Application of the evaluation plan (HTA Project report No. 31b)

Background:
Cardiac rehabilitation is an essential therapeutic step in ensuring patient reintegration into work-, social- and family life following acute cardiac incidents or cardiac surgical procedures. Phase I of the cardiac rehabilitation is conducted in inpatients in terms of early mobilisation after an acute incident. The phase II cardiac rehabilitation normally takes 4-6 weeks and in many countries this is performed on an outpatient basis. In Austria only a small number of cardiac patients participate in outpatient rehabilitation programs. However, the outpatient cardiac rehabilitation is assumed to be as effective and safe as inpatient rehabilitation care and in addition is more cost-effective. Phase III is always conducted on an outpatient basis and should support the sustainability of the rehabilitation.

In 2008, the first parts of this project (“outpatient cardiac rehabilitation”) were finished. The objective, on the one hand, was to identify indicators and methods which are suitable for the formative and summative evaluation of outpatient cardiac rehabilitation, and on the other hand, to conduct a comparative analysis of various rehabilitation models of Phase II as well as an analysis of the efficacy of Phase III interventions.

Aims and research objectives:
Because of the observed great heterogeneity of the programs in regards to the contents and models of rehabilitation we suggested the evaluation of Austrian rehabilitation programs to prove their effectiveness. Therefore a retrospective cohort study based on clinical data from patients who attended cardiac rehabilitation centers and account data from health insurance institutions was planned.

The first objective was the estimation of the effectiveness of outpatient cardiac phase III rehabilitation. The second objective was to give decision guidance for the Association of Austrian Health Insurance Providers for negotiations concerning the prolongation of contacts between them and outpatient rehabilitation centers.

Methods
In a first step we developed an evaluation concept based on the analysis of the centre for outpatient rehabilitation (ZAR) owned by the Pension Insurance institution (HTA Project report No. 31a). In a second step we applied the concept to the centers of the working group on outpatient cardiac prevention and rehabilitation (AGAKAR)(HTA Project report No. 31b).