Table 5.
Effect on clinical performance measured by 11 care processes and six patient outcomes (primary outcome): complete case analysis including correction for case mix
| Care processes and patient outcomes | Type | Control group | Intervention group | P value | N (centres) | Missing values | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Crude baseline performance | Crude follow-up performance | Adjusted performance trend [OR (95% CI)] | Crude baseline performance | Crude follow-up performance | Adjusted performance trend [OR (95% CI)] | |||||
| Psychosocial rehabilitation (study group A) | ||||||||||
| 1. Complete data on psychological functioning | Process | 67.1% (425/633) | 70.4% (2703/3842) | 0.56 (0.25 to 1.25) | 86.8% (1474/1698) | 85.6% (5495/6420) | 0.82 (0.31 to 2.17) | 0.690 | 12,593 (18) | 0 (0%) |
| 2. Complete data on social functioning | Process | 20.2% (128/633) | 17.3% (666/3842) | 0.14 (0.01 to 1.91) | 56.2% (955/1698) | 56.2% (3608/6420) | 0.12 (0.01 to 1.95) | 0.131 | 12,593 (18) | 0 (0%) |
| 3. Complete data on lifestyle factors | Process | 83.3% (527/633) | 86.0% (3304/3842) | 0.90 (0.45 to 1.83) | 86.3% (1465/1698) | 80.7% (5180/6420) | 0.79 (0.32 to 1.98) | 0.619 | 12,593 (18) | 0 (0%) |
| 4. Disease specific education completeda | Process | 36.3% (61/168) | 46.5% (451/970) | 0.59 (0.44 to 0.77) | 48.9% (149/305) | 69.4% (738/1064) | 0.39 (0.26 to 0.60) | 0 | 2507 (10) | 1589 (38.8%) |
| 5. Lifestyle modification programme completeda | Process | 51.4% (19/37) | 42.7% (108/253) | 0.63 (0.17 to 2.42) | 21.3% (61/286) | 33.3% (235/706) | 1.24 (0.19 to 8.01) | 0.819 | 1282 (9) | 1541 (54.6%) |
| 6. Improved quality of live after CR | Outcome | 47.0% (70/149) | 48.8% (471/966) | 1 (0.76 to 1.33) | 46.6% (275/590) | 49.0% (1182/2412) | 0.96 (0.69 to 1.33) | 0.793 | 4117 (17) | 8476 (67.3%) |
| 7. Successful smoking cessation | Outcome | 63.0% (63/100) | 58.3% (277/475) | 0.91 (0.65 to 1.29) | 54.1% (119/220) | 58.5% (424/725) | 0.84 (0.56 to 1.26) | 0.392 | 1520 (17) | 11,073 (87.9%) |
| 8. Patients receive a discharge letter with remaining lifestyle goals | Process | 9.1% (24/263) | 17.8% (209/1173) | 5.35 (0.58 to 49.38) | 15.5% (161/1037) | 26.7% (1004/3755) | 2.06 (0.13 to 31.63) | 0.609 | 6228 (18) | 6365 (50.5%) |
| Physical rehabilitation (study group B) | ||||||||||
| 9. Complete data on physical functioning | Process | 56.0% (950/1698) | 64.1% (4118/6420) | 1.66 (0.90 to 3.05) | 57.8% (366/633) | 67.8% (2605/3842) | 0.97 (0.35 to 2.73) | 0.956 | 12,593 (18) | 0 (0%) |
| 10. Complete data concerning cardiovascular risk factors | Process | 53.5% (909/1698) | 48.6% (3123/6420) | 1.13 (0.76 to 1.70) | 54.8% (347/633) | 62.9% (2415/3842) | 0.86 (0.45 to 1.65) | 0.657 | 12,593 (18) | 0 (0%) |
| 11. Exercise training completeda | Process | 55.0% (364/662) | 50.2% (1124/2239) | 1.17 (0.49 to 2.77) | 75.0% (3/4) | NA (0/0) | 0 (0 to Inf) | 1 | 2905 (9) | 2929 (50.2%) |
| 12. Relaxation and stress management training completeda | Process | 35.0% (143/409) | 51.4% (721/1404) | 0.40 (0.09 to 1.72) | 40.0% (6/15) | 32.7% (145/443) | 3.56 (0.16 to 79.38) | 0.418 | 2271 (11) | 518 (18.6%) |
| 13. Cardiovascular risk factors evaluated at discharge | Process | 12.1% (156/1286) | 8.8% (360/4085) | 0.51 (0.10 to 2.66) | 48.7% (218/448) | 41.1% (970/2359) | 0.49 (0.04 to 5.46) | 0.567 | 8178 (18) | 4415 (35.1%) |
| 14. Improvement in exercise capacity | Outcome | 50.8% (199/392) | 59.5% (966/1624) | 1.14 (0.95 to 1.36) | 57.1% (96/168) | 51.0% (490/960) | 1.22 (0.89 to 1.68) | 0.224 | 3144 (12) | 9449 (75.0%) |
| 15. Successful work resumption | Outcome | 65.2% (204/313) | 59.8% (539/901) | 1.07 (0.80 to 1.44) | 80.4% (86/107) | 81.1% (456/562) | 0.86 (0.51 to 1.46) | 0.577 | 1883 (17) | 10,710 (85.1%) |
| 16. Moderately active lifestyle norm met at discharge | Outcome | 27.3% (229/839) | 32.0% (781/2439) | 1.45 (0.98 to 2.13) | 75.9% (271/357) | 75.7% (1249/1650) | 1.26 (0.69 to 2.33) | 0.457 | 5285 (17) | 7308 (58.0%) |
| 17. Vigorously active lifestyle norm met at discharge | Outcome | 9.2% (77/834) | 19.2% (467/2438) | 1.36 (1.04 to 1.79) | 21.7% (74/341) | 21.8% (354/1623) | 1.32 (0.92 to 1.90) | 0.129 | 5236 (17) | 7357 (58.4%) |
Baseline period: first 3 months of study period; follow-up period: complete study period minus the baseline period. Performance trends: odds ratios associated with a 1-year study follow-up, adjusted for patients’ age, gender, indication for CR, and centres’ type and size. P value: probability of trends being similar in intervention and control group
Abbreviations: CI confidence interval, CR cardiac rehabilitation, OR odds ratio, NA not applicable
We excluded centres with incomplete data for this indicator. The number of centres and patients included in the analyses was therefore as follows: indicator 4: 12 centres, 11,174 patients; indicator 5: 15 centres, 12,649 patients; indicator 11: 16 centres, 12,915 patients; and indicator 12: 15 centres, 11,324 patients