PrintDownload PDFGet Adobe ReaderDownload to WordDownload as HTMLDownload as XMLCitation Manager
Save to Favorites
Measure Summary
This measure is endorsed by the National Quality Forum
Title
Cardiac rehabilitation: percentage of patients in an outpatient clinical practice who have had a qualifying event/diagnosis during the previous 12 months, who have been referred to an outpatient cardiac rehabilitation program.
Source(s)
American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Cardiology Foundation, American Heart Association Task Force on Performance Measures, Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol. 2010 Sep 28;56(14):1159-67. PubMed External Web Site Policy

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, ACCFAHA Task Force on Performance Measures. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: A report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American [trunc]. J Cardiopulm Rehabil Prev. 2010 Sep-Oct;30(5):279-88. PubMed External Web Site Policy

Writing Committee Members, Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: a report of the American Association of Cardiovascular and Pulmonary Rehabilitation [trunc]. Circulation. 2010 Sep 28;122(13):1342-50. [19 references] PubMed External Web Site Policy

Measure Domain

Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure

Brief Abstract

Description

This measure is used to assess the percentage of patients evaluated in an outpatient setting who in the previous 12 months have experienced an acute myocardial infarction, new or worsening angina that does not meet criteria for unstable angina, or who have undergone coronary artery bypass (CABG) surgery, a percutaneous coronary intervention (PCI), cardiac valve surgery (CVS), or cardiac transplantation, who have not already participated in an early outpatient cardiac rehabilitation/secondary prevention program for the qualifying event, and who are referred to an outpatient cardiac rehabilitation/secondary prevention program.

Rationale

There has been growing scientific evidence over the past 3 decades on the benefits of cardiac rehabilitation (CR) services for persons with cardiovascular disease (CVD). Evidence suggests that the benefits of CR services are as significant in recent years as they were in the prethrombolytic era. Because of this mounting evidence, a number of healthcare organizations have endorsed the use of CR services in persons with CVD by including provisions for CR in their practice guidelines and practice management position papers.

Despite both the known benefits of CR and the widespread endorsement of its use, CR is vastly underutilized, with less than 30% of eligible patients participating in a CR program after a CVD event. Reasons for this gap in CR participation are numerous, but the most critical and potentially most correctable reasons revolve around obstacles in the initial referral of patients to CR programs. These obstacles can be reduced through the systematic adoption of standing orders and other similar tools for CR referral for appropriate hospitalized patients. Furthermore, physician accountability associated with the use of these performance measures may lead to new and novel approaches to improve both referral rates and the outcome of patients with CVD.

A key component for CR utilization is the appropriate and timely referral of patients to an outpatient CR program. While referral takes place generally when the patient is hospitalized for a qualifying event (myocardial infarction [MI], chronic stable angina [CSA], coronary artery bypass graft [CABG] surgery, percutaneous coronary intervention [PCI], cardiac valve surgery, or heart transplantation), there are many instances in which a patient can and should be referred from an outpatient clinical practice setting (e.g., when a patient does not receive such a referral while in the hospital, or when the patient fails to follow through with the referral for whatever reason). This performance measure has been developed to help healthcare systems implement effective steps in their systems of care that would optimize the appropriate referral of a patient to an outpatient CR program.

This measure is designed to serve as a stand-alone measure or, preferably, to be included within other performance measurement sets that involve disease states or other conditions for which CR services have been found to be appropriate and beneficial (e.g., following MI, CABG surgery).

Referral of appropriate outpatients to a CR program is the responsibility of the healthcare provider within a healthcare system that is providing the primary cardiovascular care to the patient in the outpatient setting.

Evidence for Rationale
Agency for Health Care Policy and Research (AHCPR), Cardiac Rehabilitation Guideline Panel. Cardiac rehabilitation. Rockville (MD): U. S. Department of Health and Human Services, Public Health Service, AHCPR ; 1995 Oct. 202 p. (Clinical practice guideline; no. 17).  [334 references]

American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Cardiology Foundation, American Heart Association Task Force on Performance Measures, Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol. 2010 Sep 28;56(14):1159-67. PubMed External Web Site Policy

Centers for Disease Control and Prevention (CDC). Receipt of cardiac rehabilitation services among heart attack survivors--19 states and the District of Columbia, 2001. MMWR Morb Mortal Wkly Rep. 2003 Nov 7;52(44):1072-5. PubMed External Web Site Policy

Centers for Medicare and Medicaid Services. Decision memo for cardiac rehabilitation programs (CAG-00089R). Baltimore (MD): Centers for Medicare and Medicaid Services, US Department of Health & Human Services; 2006.

Cortes O, Arthur HM. Determinants of referral to cardiac rehabilitation programs in patients with coronary artery disease: a systematic review. Am Heart J. 2006 Feb;151(2):249-56. [38 references] PubMed External Web Site Policy

Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, Hart JC, Herrmann HC, Hillis LD, Hutter AM Jr, Lytle BW, Marlow RA, Nugent WC, Orszulak TA, Antman EM, Smith SC Jr, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Ornato JP. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2004 Aug 31;110(9):1168-76. [26 references] PubMed External Web Site Policy

Fonarow GC, Gawlinski A, Moughrabi S, Tillisch JH. Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol. 2001 Apr 1;87(7):819-22. PubMed External Web Site Policy

Goble AJ, Worchester M. Best practice guidelines for cardiac rehabilitation and secondary prevention: a synopsis. Produced on behalf of Victoria Department of Human Services. [internet]. Melbourne, Australia: Heart Research Centre; 1999 [accessed 2007 Jun 22].

Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, Thompson PD, Williams MA, Lauer MS. Cardiac rehabilitation and secondary prevention of coronary heart disease: an AHA scientific statement from the Council on Clinical Cardiology and the Council on Nutrition, Physical Activity, and Metabolism, in collaboration with AACVPR. Circulation. 2005 Jan 25;111(3):369-76. PubMed External Web Site Policy

Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, Ganiats TG, Gomes AS, Gornik HL, Gracia C, Gulati M, Haan CK, Judelson DR, Keenan N, Kelepouris E, Michos ED, Newby LK, Oparil S, Ouyang P, Oz MC, Petitti D, Pinn VW, Redberg RF, Scott R, Sherif K, Smith SC Jr, Sopko G, Steinhorn RH, Stone NJ, Taubert KA, Todd BA, Urbina E, Wenger NK, Expert Panel/Writing Group, American Heart Association, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Cardiology Foundation, Society of Thoracic Surgeons, American Medical Women's Association, Centers for Disease Control and Prevention, Office of Research on Women's Health, Association of Black Cardiologists, American College of Physicians, World Heart Federation, National Heart, Lung, and Blood Institute, American College of Nurse Practitioners. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007 Mar 20;115(11):1481-501. [23 references] PubMed External Web Site Policy

Oldridge NB, Guyatt GH, Fischer ME, Rimm AA. Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. JAMA. 1988 Aug 19;260(7):945-50. PubMed External Web Site Policy

Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB 3rd, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention-summary article: a report of the ACC/AHA Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to update the 2001 guidelines for percutaneous coronary intervention). J Am Coll Cardiol. 2006 Jan 3;47(1):216-35. PubMed External Web Site Policy

Stone JA, Arthur HM, Canadian Association of Cardiac Rehabilitation Guidelines Writing Group. Canadian guidelines for cardiac rehabilitation and cardiovascular disease prevention, second edition, 2004: executive summary. Can J Cardiol. 2005 Oct;21 Suppl D:3D-19D. PubMed External Web Site Policy

Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004 May 15;116(10):682-92. [75 references] PubMed External Web Site Policy

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, ACC/AHA Task Force Members. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. J Cardiopulm Rehabil Prev. 2007 Sep-Oct;27(5):260-90. [74 references] PubMed External Web Site Policy

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, ACCFAHA Task Force on Performance Measures. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: A report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American [trunc]. J Cardiopulm Rehabil Prev. 2010 Sep-Oct;30(5):279-88. PubMed External Web Site Policy

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, American Association of Cardiovascular and Pulmonary Rehabilitation/American. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. Circulation. 2007 Oct 2;116(14):1611-42. [74 references] PubMed External Web Site Policy

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, Bonow RO, Estes NA 3rd, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ, Rumsfeld JS, Whitman GR, AACVPR, ACC, AHA, American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, Society of Thoracic Surgeons. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol. 2007 Oct 2;50(14):1400-33. [74 references] PubMed External Web Site Policy

Thomas RJ, Miller NH, Lamendola C, Berra K, Hedback B, Durstine JL, Haskell W. National Survey on Gender Differences in Cardiac Rehabilitation Programs. Patient characteristics and enrollment patterns. J Cardiopulm Rehabil. 1996 Nov-Dec;16(6):402-12. PubMed External Web Site Policy

Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, Reeder GS, Roger VL. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol. 2004 Sep 1;44(5):988-96. PubMed External Web Site Policy

Writing Committee Members, Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: a report of the American Association of Cardiovascular and Pulmonary Rehabilitation [trunc]. Circulation. 2010 Sep 28;122(13):1342-50. [19 references] PubMed External Web Site Policy
Primary Health Components

Acute myocardial infarction (AMI); chronic stable angina (CSA); coronary artery bypass graft (CABG) surgery; percutaneous coronary intervention (PCI); cardiac valve surgery; cardiac transplantation; outpatient cardiac rehabilitation; referral

Denominator Description

Number of patients in an outpatient clinical practice who have had a qualifying event/diagnosis during the previous 12 months who do not meet any of the specified exclusion criteria (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients in an outpatient clinical practice who have had a qualifying event/diagnosis during the previous 12 months, who have been referred to an outpatient cardiac rehabilitation (CR) program (see the related "Numerator Inclusions/Exclusions" field)

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure

Women and the elderly are two populations who are least likely to be referred to early outpatient cardiac rehabilitation programs, despite the fact that they stand to benefit at least as much from such services as other population groups.

Evidence for Additional Information Supporting Need for the Measure
Cortes O, Arthur HM. Determinants of referral to cardiac rehabilitation programs in patients with coronary artery disease: a systematic review. Am Heart J. 2006 Feb;151(2):249-56. [38 references] PubMed External Web Site Policy

Thomas RJ, Miller NH, Lamendola C, Berra K, Hedback B, Durstine JL, Haskell W. National Survey on Gender Differences in Cardiac Rehabilitation Programs. Patient characteristics and enrollment patterns. J Cardiopulm Rehabil. 1996 Nov-Dec;16(6):402-12. PubMed External Web Site Policy
Extent of Measure Testing

The Cardiac Rehabilitation/Secondary Prevention Performance Measure Writing Committee initially identified 39 factors from various practice guidelines and other reports that were considered potential performance measures for the Cardiac Rehabilitation/Secondary Prevention Performance Measurement Sets (see Table 1 in the document "AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services" for standard guidelines that were used to rate the classification of recommendations and level of evidence for assessing these factors). The group evaluated these factors according to guidelines established by the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Task Force on Performance Measures. Those measures that were deemed to be most evidence-based, interpretable, actionable, clinically meaningful, valid, reliable, and feasible were included in the final performance measurement sets. Once these measures were identified, the writing committee then discussed and refined, over a series of months, the definition, content, and other details of each of the selected measures.

In 2011-2012, additional testing was conducted: Hospitals and clinical practices from around the U.S. were recruited to participate in this testing project. Twenty-nine hospitals and 23 outpatient centers expressed interest in participating. Seven hospitals and 6 outpatient centers met participation criteria and submitted completed data. Site coordinators identified 35 patients whose charts were reviewed by 2 site abstractors twice, one week apart.

Percent agreement and Cohen's kappa statistic were used to describe intra- and inter-abstractor reliability for patient eligibility for CR/SP, patient exceptions for CR/SP referral, and documented referral to CR/SP. Results were obtained from within-site data, as well as from pooled data of all inpatient and all outpatient sites.

We found that intra-abstractor reliability reflected excellent repeatability (≥90% agreement, κ ≥0.75) for ratings of CR/SP eligibility, exceptions, and referral, both from pooled and site-specific analyses of inpatient and outpatient data. Similarly, the inter- abstractor agreement from pooled analysis ranged from good to excellent for the three items, although with slightly lower measures of reliability.

On the basis of these testing results, the National Quality Forum (NQF) upgraded the endorsement status of this measure from time-limited to endorsed.

Evidence for Extent of Measure Testing
Spertus JA, Eagle KA, Krumholz HM, Mitchell KR, Normand SL, American College of Cardiology/American Heart Association Task Force on. American College of Cardiology and American Heart Association methodology for the selection and creation of performance measures for quantifying the quality of cardiovascular care. J Am Coll Cardiol. 2005 Apr 5;45(7):1147-56. PubMed External Web Site Policy

Thomas RJ, Chiu JS, Goff DC, King M, Lahr B, Lichtman SW, Lui K, Pack Q, Shahriary M. Reliability of Abstracting Performance Measures: Results of the Cardiac Rehabilitation Referral and Reliability (CR3) Project. J Cardiopulm Rehabil Prev. 2013;In press.

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, ACC/AHA Task Force Members. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. J Cardiopulm Rehabil Prev. 2007 Sep-Oct;27(5):260-90. [74 references] PubMed External Web Site Policy

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, American Association of Cardiovascular and Pulmonary Rehabilitation/American. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. Circulation. 2007 Oct 2;116(14):1611-42. [74 references] PubMed External Web Site Policy

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, Bonow RO, Estes NA 3rd, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ, Rumsfeld JS, Whitman GR, AACVPR, ACC, AHA, American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, Society of Thoracic Surgeons. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol. 2007 Oct 2;50(14):1400-33. [74 references] PubMed External Web Site Policy

State of Use of the Measure

State of Use
Current routine use
Current Use
External oversight/Medicare
Internal quality improvement
Pay-for-reporting
Public reporting

Application of the Measure in its Current Use

Measurement Setting
Ambulatory/Office-based Care
Hospital Outpatient
Professionals Involved in Delivery of Health Services
Advanced Practice Nurses
Physician Assistants
Physicians
Least Aggregated Level of Services Delivery Addressed
Individual Clinicians or Public Health Professionals
Statement of Acceptable Minimum Sample Size
Unspecified
Target Population Age

Age 18 or older

Target Population Gender
Either male or female

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Prevention and Treatment of Leading Causes of Mortality

Institute of Medicine (IOM) National Health Care Quality Report Categories

IOM Care Need
Getting Better
IOM Domain
Effectiveness

Data Collection for the Measure

Case Finding Period

The previous 12 months

Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Clinical Condition
Encounter
Therapeutic Intervention
Denominator Time Window
Time window follows index event
Denominator Inclusions/Exclusions

Inclusions
Number of patients in an outpatient clinical practice who have had a qualifying event/diagnosis* during the previous 12 months and who do not meet any of the exclusion criteria, and who have not participated in an outpatient cardiac rehabilitation program since the qualifying event/diagnosis

Note: Refer to the Data Supplement in the original measure documentation for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Current Procedural Terminology (CPT) Category II codes related to this measure.

*All patients who have experienced:

  • An acute myocardial infarction (MI),
  • Coronary artery bypass graft (CABG) surgery,
  • A percutaneous coronary intervention (PCI),
  • Cardiac valve surgery, or
  • Cardiac transplantation

Or who have:

  • Chronic stable angina (CSA)

Exclusions

  • Patient factors (e.g., patient resides in a long-term nursing care facility)
  • Medical factors (e.g., patient deemed by provider to have a medically unstable, life-threatening condition)
  • Health care system factors (e.g., no cardiac rehabilitation program available within 60 min of travel time from the patient's home)
Exclusions/Exceptions
Medical factors addressed
Patient factors addressed
System factors addressed
Numerator Inclusions/Exclusions

Inclusions
Number of patients in an outpatient clinical practice who have had a qualifying event/diagnosis during the previous 12 months, who have been referred* to an outpatient cardiac rehabilitation (CR) program

Note: The program may include a traditional CR program based on face-to-face interactions and training sessions or may include other options such as home-based approaches. If alternative CR approaches are used, they should be designed to meet appropriate safety standards.

*A referral is defined as an official communication between the healthcare provider and the patient to recommend and carry out a referral order to an outpatient CR program. This includes the provision of all necessary information to the patient that will allow the patient to enroll in an outpatient CR program. This also includes a written or electronic communication between the healthcare provider or healthcare system and the cardiac rehabilitation program that includes the patient's enrollment information for the program. A hospital discharge summary or office note may potentially be formatted to include the necessary patient information to communicate to the CR program (e.g., the patient's cardiovascular history, testing, and treatments). According to standards of practice for cardiac rehabilitation programs, care coordination communications are sent to the referring provider, including any issues regarding treatment changes, adverse treatment responses, or new nonemergency condition (new symptoms, patient care questions, etc.) that need attention by the referring provider. These communications also include a progress report once the patient has completed the program. All communications must maintain an appropriate level of confidentiality as outlined by the 1996 Health Insurance Portability and Accountability Act (HIPAA).

Exclusions
Unspecified

Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Electronic health/medical record
Paper medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure

Unspecified

Computation of the Measure

Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Rate/Proportion
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
Internal time comparison

Identifying Information

Original Title

Performance measure A-2: cardiac rehabilitation patient referral from an outpatient setting.

Submitter
American Association of Cardiovascular and Pulmonary Rehabilitation/American College of Cardiology Foundation/American Heart Association
Developer
American Association of Cardiovascular and Pulmonary Rehabilitation/American College of Cardiology Foundation/American Heart Association
Funding Source(s)

The Writing Committee had one face-to-face meeting at the outset of the writing project. Funding travel to the meeting was covered by the respective organizations (American Association of Cardiovascular and Pulmonary Rehabilitation [AACVPR], American College of Cardiology Foundation [ACCF], and American Heart Association [AHA]). Conference calls were paid for by AACVPR. Other than in these cases, there were no other funding sources or reimbursements provided.

Composition of the Group that Developed the Measure

Writing Committee Members: Randal J. Thomas, MD, MS, FAACVPR, FACC, FAHA, Chair; Marjorie King, MD, FAACVPR, FACC; Karen Lui, RN, MS, FAACVPR; Neil Oldridge, PHD, FAACVPR, FACSM; Ileana L. Piña, MD, FACC; John Spertus, MD, MPH, FACC

American Association of Cardiovascular and Pulmonary Rehabilitation: P. Joanne Ray, CFRE, Executive Director; Abigail Lynn, Senior Coordinator

American College of Cardiology Foundation: John C. Lewin, MD, Chief Executive Officer; Charlene May, Senior Director, Clinical Policy and Documents; Melanie Shahriary, RN, BSN, Director, Performance Measures and Data Standards; Erin A. Barrett, MPS, Senior Specialist, Clinical Policy and Documents

American Heart Association: Nancy Brown, Chief Executive Officer; Rose Marie Robertson, MD, FACC, FAHA, Chief Science Officer; Gayle R. Whitman, PhD, RN, FAHA, FAAN, Senior Vice President, Office of Science Operations; Dorothea K. Vafiadis, MS, Science and Medicine Advisor

American College of Cardiology Foundation/American Heart Association: Jensen S. Chiu, MHA, Specialist, Clinical Performance Measurement

Financial Disclosures/Other Potential Conflicts of Interest

Author Relationships with Industry and Other Entities--American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)/American College of Cardiology (ACC)/American Heart Association (AHA) 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services

Name Employment Consultant Speaker Ownership/
Partnership/Principal
Research Institutional, Organizational, or Other Financial Benefit Expert Witness

Randal J. Thomas

Mayo Clinic

None

None

None

None

None

None

Marjorie King

Helen Hayes Hospital and Hudson Heart Associates

None

None

None

None

None

None

Karen Lui

GRQ, LLC

None

None

None

None

None

None

Neil Oldridge

University of Wisconsin School of Medicine and Public Health

None

None

Copyright for MacNew

None

None

None

Ileana L. Piña

University Hospitals Case Medical Center

  • Food and Drug Administration
  • Sanofi-Aventis
  • AstraZeneca
  • Merck
  • Novartis

None

None

None

None

John Spertus

MidAmerica Heart Institute of St. Luke's Hospital

  • St. Jude Medical
  • United Healthcare Scientific Advisory Board

None

  • Copyright for Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire, and Peripheral Artery Questionnaire*
  • PRISM Technology
  • American College of Cardiology Foundation*
  • Amgen*
  • Bristol-Myers Squibb/Sanofi- Aventis Partnership*
  • Johnson & Johnson*
  • Eli Lilly & Co.*
  • CV Outcomes, Inc. (President of this 501(C)3 organization)
  • Health Outcomes Sciences, LLC (ownership interest)
  • Outcomes Instruments, LLC (ownership interest)

None

Note: This table represents the relationships of committee members with industry and other entities that were reported by authors to be relevant to this document. These relationships were reviewed and updated in conjunction with all meetings and/or conference calls of the writing committee during the document development process. The table does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of 5% or more of the voting stock or share of the business entity, or ownership of $10,000 or more of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person's gross income for the previous year. A relationship is considered to be modest if it is less than significant under the preceding definition. Relationships in this table are modest unless otherwise noted.

*Significant (greater than $10,000) relationship.

Endorser
American College of Chest Physicians
American College of Sports Medicine
American Physical Therapy Association
Canadian Association of Cardiac Rehabilitation
Clinical Exercise Physiology Association
Inter-American Heart Foundation
National Association of Clinical Nurse Specialists
National Quality Forum
Preventive Cardiovascular Nurses Association
Society of Thoracic Surgeons
NQF Number
0643
Date of Endorsement

National Quality Forum: 2014 Sep 8

Measure Initiative(s)
Physician Quality Reporting System
Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC
2010 Aug
Measure Maintenance

Unspecified

Date of Next Anticipated Revision

2013

Measure Status

This is the current release of the measure.

This measure updates a previous version: Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, American Association of Cardiovascular and Pulmonary Rehabilitation/American. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. Circulation 2007 Oct 2;116(14):1611-42. [74 references]

The measure developer reaffirmed the currency of this measure in October 2014.

Source(s)
American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Cardiology Foundation, American Heart Association Task Force on Performance Measures, Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol. 2010 Sep 28;56(14):1159-67. PubMed External Web Site Policy

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, ACCFAHA Task Force on Performance Measures. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: A report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American [trunc]. J Cardiopulm Rehabil Prev. 2010 Sep-Oct;30(5):279-88. PubMed External Web Site Policy

Writing Committee Members, Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: a report of the American Association of Cardiovascular and Pulmonary Rehabilitation [trunc]. Circulation. 2010 Sep 28;122(13):1342-50. [19 references] PubMed External Web Site Policy
Measure Availability

The individual measure, "Performance Measure A-2: Cardiac Rehabilitation Patient Referral from an Outpatient Setting," is published in "AACVPR/ACC/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services." This article is available from the American Heart Association Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on July 18, 2008. The information was verified by the measure developer on September 3, 2008.

This NQMC summary was retrofitted into the new template on June 9, 2011.

This NQMC summary was updated by ECRI Institute on December 21, 2011. The information was verified by the measure developer on February 1, 2012.

The information was reaffirmed by the measure developer on October 14, 2014.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

Disclaimer

NQMC Disclaimer

The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

Read full disclaimer...