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Cardiac rehabilitation and secondary prevention services in Ontario: recommendations from a consensus panel.

https://arctichealth.org/en/permalink/ahliterature184870
Source
Can J Cardiol. 2003 Jun;19(7):833-8
Publication Type
Article
Date
Jun-2003
Author
Neville Suskin
Susan MacDonald
Terri Swabey
Heather Arthur
Mark A Vimr
Ravi Tihaliani
Author Affiliation
London Health Sciences Centre, Ontario, Canada. nsuskin@uwo.ca
Source
Can J Cardiol. 2003 Jun;19(7):833-8
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Cardiac Care Facilities - economics - organization & administration
Cardiology - education - organization & administration
Cardiovascular Diseases - rehabilitation
Consensus Development Conferences as Topic
Continuity of Patient Care - organization & administration
Cost-Benefit Analysis
Delivery of Health Care, Integrated - organization & administration
Health Care Surveys
Health Planning - organization & administration
Health Services Accessibility
Humans
Needs Assessment
Ontario
Practice Guidelines as Topic
Preventive Health Services - economics - organization & administration
Social Responsibility
Abstract
The Cardiac Care Network of Ontario Consensus Panel on Cardiac Rehabilitation and Secondary Prevention drew on the literature and its own expertise, and surveyed existing cardiac rehabilitation and secondary prevention (CR) services in Ontario to make recommendations for the delivery of CR services in Ontario. This report, which is not an official position paper for the Canadian Cardiovascular Society, presents these recommendations. The key recommendations were a regional coordination model for the delivery of CR services that would provide CR close to home and promote access to CR in groups traditionally underrepresented in CR; high quality central data collection; the creation of a provincial CR registry to allow future planning, coordination, monitoring and evaluation of CR services in Ontario; and the establishment of specific CR program funding from the Ontario Ministry of Health and Long Term Care.
PubMed ID
12813617 View in PubMed
Less detail

Cardiologists' charting varied by risk factor, and was often discordant with patient report.

https://arctichealth.org/en/permalink/ahliterature157753
Source
J Clin Epidemiol. 2008 Oct;61(10):1073-9
Publication Type
Article
Date
Oct-2008
Author
Shannon Gravely-Witte
Donna E Stewart
Neville Suskin
Lyall Higginson
David A Alter
Sherry L Grace
Author Affiliation
University Health Network Women's Health Program, 200 Elizabeth St., Toronto, Ontario, Canada. sgravely@yorku.ca
Source
J Clin Epidemiol. 2008 Oct;61(10):1073-9
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - epidemiology - etiology
Clinical Competence
Diabetes Mellitus - epidemiology
Dyslipidemias - complications - epidemiology
Epidemiologic Methods
Female
Humans
Hypertension - complications - epidemiology
Male
Medical Records - standards
Middle Aged
Ontario - epidemiology
Outpatient Clinics, Hospital
Self Disclosure
Smoking - adverse effects - epidemiology
Socioeconomic Factors
Abstract
To assess the completeness of cardiac risk factor documentation by cardiologists, and agreement with patient report.
A total of 68 Ontario cardiologists and 789 of their ambulatory cardiology patients were randomly selected. Cardiac risk factor data were systematically extracted from medical charts, and a survey was mailed to participants to assess risk factor concordance.
With regard to completeness of risk factor documentation, 90.4% of charts contained a report of hypertension, 87.2% of diabetes, 80.5% of dyslipidemia, 78.6% of smoking behavior, 73.0% of other comorbidities, 48.7% of family history of heart disease, and 45.9% of body mass index or obesity. Using Cohen's k, there was a concordance of 87.7% between physician charts and patient self-report of diabetes, 69.5% for obesity, 56.8% for smoking status, 49% for hypertension, and 48.4% for family history.
Two of four major cardiac risk factors (hypertension and diabetes) were recorded in 90% of patient records; however, arguably the most important reversible risk factors for cardiac disease (dyslipidemia and smoking) were only reported 80% of the time. The results suggest that physician chart report may not be the criterion standard for quality assessment in cardiac risk factor reporting.
Notes
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PubMed ID
18411042 View in PubMed
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Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study.

https://arctichealth.org/en/permalink/ahliterature154911
Source
Eur J Cardiovasc Prev Rehabil. 2008 Oct;15(5):548-56
Publication Type
Article
Date
Oct-2008
Author
Sherry L Grace
Shannon Gravely-Witte
Janette Brual
George Monette
Neville Suskin
Lyall Higginson
David A Alter
Donna E Stewart
Author Affiliation
York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada. sgrace@yorku.ca
Source
Eur J Cardiovasc Prev Rehabil. 2008 Oct;15(5):548-56
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Coronary Artery Disease - rehabilitation
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
Male
Marital status
Middle Aged
Ontario
Outpatients - psychology
Patient Education as Topic
Patient Participation
Patient Selection
Perception
Physician's Role
Physician-Patient Relations
Prospective Studies
Questionnaires
Referral and Consultation
Abstract
Cardiac rehabilitation (CR) is an established means of reducing mortality, yet is grossly underutilized. This is due to both health system and patient-level factors; issues that have yet to be investigated concurrently. This study utilized a hierarchical design to examine physician and patient-level factors affecting verified CR enrollment.
A prospective multisite study, using a multilevel design of 1490 coronary artery disease outpatients nested within 97 Ontario cardiology practices (mean 15 per cardiologist).
Cardiologists completed a survey regarding CR attitudes. Outpatients were surveyed prospectively to assess factors affecting CR enrollment. Patients were mailed a follow-up survey 9 months later to self-report CR enrollment. This was verified with 40 CR sites.
Five hundred and fifty (43.4%) outpatients were referred, and 469 (37.0%) enrolled in CR. In mixed logistic regression analyses, factors affecting verified CR enrollment were greater strength of physician endorsement (P=0.005), shorter distance to CR (P=0.001), being married (P=0.01), and fewer perceived CR barriers (P=0.03).
Both physician and patient factors play a part in CR enrollment. Patient CR barriers should be addressed during referral discussions, and reasons why physicians fail to uniformly endorse CR exploration. Although distance to CR was related to patient enrollment patterns, greater access to home-based CR services should be provided.
Notes
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PubMed ID
18830085 View in PubMed
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Contribution of patient and physician factors to cardiac rehabilitation referral: a prospective multilevel study.

https://arctichealth.org/en/permalink/ahliterature156787
Source
Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):653-62
Publication Type
Article
Date
Oct-2008
Author
Sherry L Grace
Shannon Gravely-Witte
Janette Brual
Neville Suskin
Lyall Higginson
David Alter
Donna E Stewart
Author Affiliation
York University, Toronto, ON, Canada. sgrace@yorku.ca
Source
Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):653-62
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - statistics & numerical data
Attitude of Health Personnel
Comprehension
Coronary Artery Disease - rehabilitation
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Health Services Research
Humans
Male
Middle Aged
Ontario
Outpatients - psychology - statistics & numerical data
Patient Education as Topic
Perception
Physician-Patient Relations
Physicians - psychology - statistics & numerical data
Prospective Studies
Quality of Health Care
Questionnaires
Referral and Consultation - statistics & numerical data
Abstract
Cardiac rehabilitation (CR), in most developed countries, is a proven means of reducing mortality but it is grossly underutilized owing to factors involving both the health system and patients. These issues have not been investigated concurrently. To this end, we employed a hierarchical design to investigate physician and patient factors that affect verified CR referral.
This study was prospective with a multilevel design. We assessed 1,490 outpatients with coronary artery disease attending 97 cardiology practices. Cardiologists completed a survey about attitudes to CR referral. Outpatients were surveyed prospectively to assess sociodemographic, clinical, behavioral, psychosocial and health system factors that affected CR referral. Responses were analyzed by mixed logistic regression analyses. After 9 months, CR referral was verified at 40 centers.
Health-care providers referred 550 (43.4%) outpatients to CR. Factors affecting verified referral included positive physician perceptions of CR (P = 0.03), short distance to the closest CR site (P = 0.003), the perception of fewer barriers to CR (P
Notes
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Cites: Prog Cardiovasc Nurs. 2002 Winter;17(1):8-1711872976
Cites: Gen Hosp Psychiatry. 2002 May-Jun;24(3):127-3412062136
Cites: Clin Rehabil. 2002 Aug;16(5):541-5212194625
Cites: J Womens Health (Larchmt). 2002 Nov;11(9):773-9112632591
Cites: Med J Aust. 2003 Oct 6;179(7):332-314503890
Cites: J Cardiopulm Rehabil. 2003 Nov-Dec;23(6):398-40314646785
Cites: Rehabil Nurs. 2004 Jan-Feb;29(1):18-2314727472
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Cites: Am J Med. 2004 May 15;116(10):682-9215121495
Cites: Med Care. 2004 Jul;42(7):661-915213491
Cites: Can J Cardiol. 2004 Sep;20(11):1101-715457306
Cites: Res Nurs Health. 1987 Dec;10(6):357-653423307
Cites: Am J Cardiol. 1989 Sep 15;64(10):651-42782256
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Comment On: Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):671-218695694
PubMed ID
18542104 View in PubMed
Less detail

Degree and correlates of patient trust in their cardiologist.

https://arctichealth.org/en/permalink/ahliterature150338
Source
J Eval Clin Pract. 2009 Aug;15(4):634-40
Publication Type
Article
Date
Aug-2009
Author
Sheena Kayaniyil
Shannon Gravely-Witte
Donna E Stewart
Lyall Higginson
Neville Suskin
David Alter
Sherry L Grace
Author Affiliation
Department of Kinesiology and Health Science, York University, Toronto, Canada.
Source
J Eval Clin Pract. 2009 Aug;15(4):634-40
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiology
Coronary Artery Disease
Female
Health Care Surveys
Humans
Male
Middle Aged
Ontario
Physician-Patient Relations
Trust
Abstract
Trust in one's doctor has been associated with increased treatment adherence, patient satisfaction and improved health status. This study investigated the level and correlates of patient trust in their cardiac specialist.
All 386 urban cardiologists in Southern Ontario (95 participating, response rate = 30%) were approached to recruit a sample of their coronary artery disease outpatients. A total of 1111 recent and consecutive patients consented to participate (approximately 13 patients per cardiologist, 317 female (26.7%); response rate = 60%), and clinical data were extracted from their medical charts. Participants completed a mailed survey including the Trust in Physicians scale, in addition to an assessment of socio-demographic, clinical and psychosocial correlates.
The mean trust score was equivalent to that reported in studies of primary care patients. Results of the significant multivariate model (F = 7.631, P
Notes
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PubMed ID
19522723 View in PubMed
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A mixed methods study of continuity of care from cardiac rehabilitation to primary care physicians.

https://arctichealth.org/en/permalink/ahliterature150225
Source
Can J Cardiol. 2009 Jun;25(6):e187-92
Publication Type
Article
Date
Jun-2009
Author
Dana L Riley
Suzan Krepostman
Donna E Stewart
Neville Suskin
Heather M Arthur
Sherry L Grace
Author Affiliation
York University, Toronto, Canada. driley@ottawaheart.ca
Source
Can J Cardiol. 2009 Jun;25(6):e187-92
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Continuity of Patient Care
Coronary Disease - rehabilitation
Female
Humans
Interviews as Topic
Male
Patient Discharge
Physicians, Family
Prescriptions
Questionnaires
Abstract
Participation in cardiac rehabilitation (CR) programs results in multiple beneficial outcomes, including decreased morbidity and mortality. In Canada, the involvement of the primary care physician post-CR should increase the likelihood of sustaining the benefits achieved by CR and enhance the continuity of care that cardiac patients receive.
To identify and describe information that is transferred from CR programs to primary care physicians in discharge summaries, and to assess the usefulness of such information from the perspective of the primary care physician.
For each of 21 Ontario CR sites to which patients from a larger study were referred, up to four primary care physicians were contacted to request a copy of the CR discharge summary received and their participation in a telephone interview. Discharge data were coded and enumerated. Qualitative data from 17 interviews were transcribed and coded based on grounded analyses.
Of the 89 primary care physicians approached, 50 participated (response rate of 61.7%). Twenty-one physicians (42.0%) received the intended discharge summary from the CR site. There was great variability in clinical and service data reported, with 52.0% reporting an exercise prescription for the home or community and 42.0% reporting current medications prescribed. Four themes requiring improvement were generated from the physician interviews: patient behavioural management issues, health system factors, efficiency of data transfer and communication issues.
Major inconsistencies were noted between clinical data communicated versus what was desired. Data relating to attendance rates, behavioural management suggestions and lipid values were among the most notable omissions.
Notes
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Comment In: Can J Cardiol. 2009 Jun;25(6):e193-419536389
PubMed ID
19536388 View in PubMed
Less detail

A multisite examination of sex differences in cardiac rehabilitation barriers by participation status.

https://arctichealth.org/en/permalink/ahliterature152864
Source
J Womens Health (Larchmt). 2009 Feb;18(2):209-16
Publication Type
Article
Date
Feb-2009
Author
Sherry L Grace
Shannon Gravely-Witte
Sheena Kayaniyil
Janette Brual
Neville Suskin
Donna E Stewart
Author Affiliation
York University, Ontario, Canada., University Health Network Women's Health Program, Ontario, Canada., University of Toronto, Ontario, Canada. sgrace@yorku.ca
Source
J Womens Health (Larchmt). 2009 Feb;18(2):209-16
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Cardiovascular Diseases - psychology - rehabilitation
Exercise - psychology
Female
Follow-Up Studies
Health Behavior
Health Knowledge, Attitudes, Practice
Health Services Accessibility - statistics & numerical data
Humans
Male
Ontario
Perception
Sex Distribution
Abstract
Despite its proven benefits and need, women are significantly less likely than men to participate in and complete cardiac rehabilitation (CR). The purpose of this study was to quantitatively investigate sex differences in CR barriers by participation status.
Cardiac outpatients (1496, 430 female, 28.7%) of 97 cardiologists completed a mailed survey to discern CR participation. Respondents were asked to rate 19 CR barriers on a 5-point Likert scale.
Five hundred twenty-nine (43%) respondents self-reported participating in CR, with men being more likely to participate (p
Notes
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PubMed ID
19183092 View in PubMed
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The Ontario Cardiac Rehabilitation Pilot Project.

https://arctichealth.org/en/permalink/ahliterature178653
Source
Can J Cardiol. 2004 Aug;20(10):957-61
Publication Type
Article
Date
Aug-2004
Author
Terri Swabey
Neville Suskin
Heather M Arthur
Jillian Ross
Author Affiliation
Cardiac Rehabilitation Pilot Project Committees, Cardiac Care Network of Ontario, 4211Yonge Street, Toronto, Ontario M2P 2A9, Canada. tswabey@ccn.on.ca
Source
Can J Cardiol. 2004 Aug;20(10):957-61
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - prevention & control - rehabilitation
Health Planning - organization & administration
Humans
Ontario
Pilot Projects
Primary Prevention - organization & administration
Program Development
Program Evaluation
Quality of Health Care
Abstract
In February 2001, the Ontario Ministry of Health and Long-Term Care announced a $9.6 million, 15-month pilot project (the Pilot) to implement and evaluate a comprehensive, multifactoral model of cardiac rehabilitation (CR) service delivery at 17 sites across Ontario. This is the second paper in a three-part, policy-related series which provides a summary of the Ontario CR Pilot model and the Pilot implementation and evaluation methodology. The aim of the present paper was to outline the goals of the Pilot, the Pilot model of care, the organizational structure that facilitated implementation of the model, and the operational procedures that were put in place to evaluate patient outcomes and the generalizability of a regional model of CR service delivery. The model was based on the findings and recommendations of the Cardiac Care Network of Ontario's 1999 Consensus Panel on Cardiac Rehabilitation and Secondary Prevention, which was described in part one of this series. An upcoming final paper will describe the outcomes of the project and its recommendations for CR health policy decisions in Ontario.
PubMed ID
15332143 View in PubMed
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The Ontario Cardiac Rehabilitation Pilot Project: Recommendations for health planning and policy.

https://arctichealth.org/en/permalink/ahliterature177855
Source
Can J Cardiol. 2004 Oct;20(12):1251-5
Publication Type
Article
Date
Oct-2004
Author
Heather M Arthur
Terri Swabey
Neville Suskin
Jillian Ross
Author Affiliation
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. arthurh@mcmaster.ca
Source
Can J Cardiol. 2004 Oct;20(12):1251-5
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - prevention & control - rehabilitation
Female
Health Planning - organization & administration
Health Planning Guidelines
Health Policy
Humans
Male
Ontario
Pilot Projects
Primary Prevention - organization & administration
Program Development
Program Evaluation
Quality of Health Care
Abstract
Expansion of cardiac rehabilitation (CR) could save both lives and costs by reducing illness and use of health care services. In February 2001, the Ontario Ministry of Health and Long-Term Care (the Ministry) announced a pilot project (the Pilot) to implement and evaluate a comprehensive, multifactoral model of CR service delivery at 17 centres across Ontario.
To design, coordinate and evaluate a coordinated model of CR service delivery, and to collect and evaluate an extensive set of clinical and administrative data.
The Pilot was a large, province-wide observational investigation of a health service delivery model for CR and secondary prevention care. The present paper is the third in a three-part, policy-related series. In the present paper, the results of the evaluation of the service delivery model and the final health policy recommendations that were made to the Ministry in September 2002 are presented.
Within approximately one year, 4922 patients were enrolled in the Pilot at participating sites throughout Ontario; 88% of sites implemented all elements of the comprehensive services model, either on-site or through internal/external partnerships, and 94% of sites implemented the multidisciplinary Pilot staffing model. Based on this rapid and near-total implementation of the Pilot model, it was concluded that the Pilot model of care was generalizable. Furthermore, regional coordination was achieved through operationalization of the coordinating centres' roles in quality management, regional planning and program development, education and outreach.
Notes
Comment In: Can J Cardiol. 2004 Oct;20(12):1256-715494779
PubMed ID
15494778 View in PubMed
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Pan-Canadian development of cardiac rehabilitation and secondary prevention quality indicators.

https://arctichealth.org/en/permalink/ahliterature256450
Source
Can J Cardiol. 2014 Aug;30(8):945-8
Publication Type
Conference/Meeting Material
Article
Date
Aug-2014
Author
Sherry L Grace
Paul Poirier
Colleen M Norris
Garth H Oakes
Deborah S Somanader
Neville Suskin
Author Affiliation
School of Kinesiology and Health Science, Faculty of Health, Toronto Western Hospital, and GoodLife Fitness Cardiovascular Rehabilitation Unit, University Health Network, Toronto, Ontario, Canada. Electronic address: sgrace@yorku.ca.
Source
Can J Cardiol. 2014 Aug;30(8):945-8
Date
Aug-2014
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Canada
Cardiovascular Diseases - prevention & control - rehabilitation
Emergencies
Exercise Tolerance
Humans
Inservice training
Outcome and Process Assessment (Health Care) - standards
Patient Education as Topic
Quality Indicators, Health Care - standards
Referral and Consultation
Secondary Prevention
Self Care
Societies, Medical
Time Factors
Abstract
The Canadian Cardiovascular Society (CCS) is implementing the Canadian Heart Health Strategy and Action Plan recommendation to build knowledge infrastructure, through its Data Definitions and Quality Indicator (QI) project. The CCS selected cardiac rehabilitation (CR) and secondary prevention as a content area for QI development. In accordance with the CCS QI Best Practice Methodology, rapid reviews of the literature were conducted. A long list of 37 QIs, in the areas of structure, process, and outcome were developed. Through an online survey, 26 (42%) of all contacted external experts rated each QI on importance, scientific acceptability, and feasibility, using a 7-point scale. The overall mean rating was 5.4 ± 1.4. Through a consensus process, the working group excluded 8 QIs based on this feedback, and several others were revised. A 30-day Web consultation was then undertaken, to solicit input from the broader CCS and CR community. A "top 5" list of QIs was requested by the CCS, which were: (1) inpatients referred to CR; (2) wait times from referral to CR enrollment; (3) patient self-management education; (4) increase in exercise capacity; and (5) emergency response strategy. Knowledge translation activities are now under way to promote utilization of the QIs and ultimately improve CR care.
PubMed ID
25064585 View in PubMed
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