National Audit of Cardiac Rehabilitation Analysis Strategy

1
National Audit of Cardiac RehabilitationAnalysis
Strategy
Making sense of the bigger picture
2
Levels of analysis
3
Areas of analysis
4

Benchmarking individual CR programmes
Benchmarking provides the opportunity for
individual CR centres to compare performance
indicators relating to their own service to that
of other centres.
And, if appropriate, to consider what can be
learnt from the performance of other centres.
Benchmarks are performance indicators not quality
indicators. The reasons why different CR
centres have different outcomes are
multi-factorial, often not under the control of
the CR centre itself. Identifying these
differences requires more complex analysis than
benchmarking.
5
Benchmarking screens on the NACR database
6
The centre, the year, the quarter and number of
records the data is based upon
7
How complete the data used for the analysis is
8
The absolute value for a given centre, how that
centre performed
9
The first, second and third quartile results for
all centres returning data
10
Performance indicators for a given centre
compared with all centres Green, above
average Amber, about average Red, below average
11
Benchmarking variables are grouped

• Descriptors of the CR programme
• NSF Targets
• Medication indicators
• Psychosocial indicators
• Quality of life indicators

Additional benchmarks can be generated, if
considered necessary by those delivering CR.
12
Looking at the outcomes of CR as a whole6365
individual records to date
13
Distribution of initial events (n 6365)
14
Key programme descriptors
15
Changes in key variables between beginning and
end of rehabilitation programmeUnadjusted
analysis
BMI
Anxiety
Depression
16
Changes in key variables between beginning and
end of rehabilitation programmeUnadjusted
analysis
17
This approach to analysis of CR as a whole
requires qualification from 2 sources.
How much change can be achieved depends on what
capacity for change exists
incorporation of covariates to adjust for
individual and centre capacity to change.
18
Integration of additional information that may
impact on CR outcomes
Living here is not quite the same as.
living here
19
Integrating additional data sources
NACR
National audit data for cardiac rehabilitation
programmes including demographics, clinical
information, short and long term outcome and
change scores.
Additional medical data to refine analysis, e.g.
Measures of disease severity, time to admission /
discharge, details of medical and surgical
treatment
CCAD datasets
HES
Prevalence statistics for cardiac events.
Geographic and demographic distribution of
cardiac events.
ONS
Overall population demographics, localised
indices of health behaviour, social deprivation,
economic activity.
CR Survey
Descriptions of individual CR programmes
including skill mix, available resources, and
service provision.
20
What will all this information achieve
21
(No Transcript)
22
Why is this important to achieve
Evidence based practice eminent academics,
suited and booted, sitting in plush offices, most
of whom have never worked in this field or seen
what actually happens in clinical practice on a
day to day basisthey read a few research papers
and decide this is what we should do, this is how
we should do it and this is what we should
achieve.
Practice based evidence The collection, collation
and analysis of core data from actual clinical
practice. To enable an understanding of what is
being achieved, how this is being achieved and
what obstacles exist to further improvement in
real clinical practice. The integration of
practice based evidence into evidence based
guidelines to create a holistic, pragmatic
interpretations of best practice in clinical care.
23
Improving services for patients.
Practice based evidence
Evidence based practice
Improving patient outcomes