National Certification Programme for Cardiovascular Rehabilitation - aiming to improve practice

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r r r r rd r r The National Ce tification P og amme fo Ca iovascula Rehabilitation – aiming to imp ove

r p actice.

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Gill Fu ze, P ofesso , Ca iovascula Rehabilitation, Covent y Unive sity, Covent y, UK an Joint

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Chai , BACPR/NACR National Ce tification P og amme fo Ca iovascula Rehabilitation (NCP_CR).

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Email: e ucation@bacp .com

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Simon Nichols, Resea ch Associate, Unive sity of Hull, Hull, UK an Exe cise Physiologist, Hull Ca iac

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Rehabilitation P og amme, City Health Ca e Pa tne ship CIC, Hull, UK.

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Pat ick Dohe ty, P ofesso , Ca iovascula Health, Unive sity of Yo k, Yo k, UK an Di ecto , National

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Au it of Ca iac Rehabilitation / Joint Chai , NCP_CR

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Sally Hinton, Executive Di ecto , B itish Association fo Ca iovascula P evention an Rehabilitation

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Alison Iliff, Health an Wellbeing P og amme anage , Public Health Englan , Yo kshi e an the

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Humbe Cent e, Lee s, UK an O ina y Office , BACPR

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Joseph ills, Consultant Ca iologist, Live pool Hea t an Chest Hospital NHS Foun ation T ust,

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Live pool, UK an P esi ent, BACPR.

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Ca iovascula isease (CVD) continues to be a lea ing cause of mo tality an mo bi ity in the UK.1_It

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is also a lea ing cont ibuto to health inequalities; e ucing excess eaths f om co ona y hea t

disease in the most ep ive fifth of a eas woul have the g eatest impact on the life expectancy d r d r d r

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gap in Englan .2

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Ca iovascula ehabilitation (CR) is a multi-facete secon a y p evention p og amme which aims to

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imp ove outcomes fo people with CVD, with st ong evi ence of clinical an cost-effectiveness,3_an_d

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is ecommen e by the National Institute fo Health an Ca e Excellence (NICE).45_{The evi ence-}_d

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base se vice stan a s fo elive y67_{inclu e cent e o home-base options (equally effective}_d _{r r} _d 8_{), by}

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a multi- isciplina y team suppo te by community se vices (such as smoking cessation). The B itish

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Association fo Ca iovascula P evention an Rehabilitation (BACPR) ecommen s that a CR

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p og amme shoul be base on seven components which have health behaviou change an

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e ucation at thei co e (Fig 1.). Quality assu ance of CR elive y is monito e , assesse an fin ings

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publishe , annually, by the B itish Hea t Foun ation fun e National Au it of Ca iac Rehabilitation

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r r r r r d r f om a majo ity of CR p og ammes ac oss most of the UK (with the exception of Scotlan ). To ensu e

data secu ity an quality NACR ata is hoste by NHS Digital.r d d d

[INSERT FIG 1 ABOUT HERE]

INEQUITY IN CR DELIVERY

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Despite its st ong evi ence-base an existing stan a s fo se vice elive y, it has become appa ent

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f om NACR epo ts ove ecent yea s that CR is not elive e equitably ac oss the UK.9_Although

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the e a e exempla y p og ammes, many clea ly fin the BACPR stan a s fo CR elive y to be

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aspi ational.10_dd_A _{itionally, it is ifficult fo commissione s, se vice lea s an patients to know}_d _r _{r r} _d _d

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whethe a pa ticula CR p og amme oes meet minimum stan a s. Conce ns about the quality of

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some CR p og amme elive y le the BACPR council an the team at NACR to collabo ate on the

development of a UK-wi e p og amme fo volunta y ce tification of whethe CR p og ammes meet d r r r r r r r r

d rd r d r minimum stan a s fo CR elive y.

MINI UM M STANDARDS FOR CERTIFICATION OF CR SERVICES

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We un e took a th ee-stage p ocess10_{to: 1) captu e the views of commissione s, se vice staff an} _r _{r r} _d

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patients on whethe a ce tification p og amme was nee e , an what woul be inclu e in the

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p ocess; 2) evelop minimum stan a s fo ce tification; an 3) pilot the ce tification p ocesses.

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The minimum stan a s we e evelope by a g oup of expe ts in CR (both aca emic an clinical)

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base on the publishe BACPR stan a s6_{(Table 1). Whe e possible, the minimum stan a s a e}_r _{d rd r}

develope f om me ian UK ata given in the NACR Annual Repo t, an these stan a s a e up ated r d d r d d rd r r d

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each yea following publication of new NACR ata. It is hope that, by annually up ating the

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minimum stan a s against the publishe ata, it will be possible ove time to ive imp ovements

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in UK elive y of CR to match the best epo te wo l wi e. In futu e, as NACR ata quality

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imp oves, it will be possible to assess patient-level outcomes fo CVD isk facto e uction an

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inco po ate ta gets fo these to be met as pa t of the ce tification p ocess.

[INSERT TABLE 1 ABOUT HERE]

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r r r r rd r Following the successful pilot, the BACPR/NACR National Ce tification P og amme fo Ca iovascula

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Rehabilitation (NCP_CR) was launche in July 2015, an this enables CR p og ammes to volunta ily

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apply fo assessment against the minimum stan a s. Gui ance is available f om

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e ucation@bacp .comwhich outlines the application p ocess an gives the cu ent minimum r d rr

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stan a s. CR r rp og ammes can equest thei NACR NCP_CR epo t an use this to assess whethe r r r r d r

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they a e likely to meet the minimum stan a s. Following payment of a small fee (to cove

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a minist ation costs) they can apply fo an assessment to be un e taken by th ee in epen ent

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membe s of the NCP_CR assessment panels. F om this they eceive fee back on whethe they meet

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cu ent minimum stan a s o not. Those that successfully meet stan a s a e ce tifie fo th ee

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yea s, an a e given gui ance on imp ovements that will be equi e p io to ece tification. These

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successful p og ammes can use the BACPR/ NACR ce tifie logo on thei pape wo k fo the th ee

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yea ce tification pe io . Those that a e unsuccessful a e given gui ance of what nee s to be one

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to meet the minimum stan a s, an this can inclu e mento ship f om a ce tifie p og amme if

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wishe . To ate, 18 CR p og ammes have successfully met the minimum stan a s fo ce tification,

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f om 24 applications.

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EXPERIENCE OF ACHIEVING CERTIFICATION: VIEW FRO A CO UNITY CR PROGRA E

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P og amme ce tification not only offe s an oppo tunity fo CR p og ammes to be ecognise

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fo high quality ca e, but also to un e take an objective self- iven eflective app aisal of the

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p og amme’s st engths an

unha nesse

potential. Du ing the application p ocess,

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p og ammes a e encou age to c itically evaluate cu ent local p actice an i entify thei

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own st ategies fo se vice evelopment. The assessment panel encou age this app oach an

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p ovi e a vice an

suppo t to each team to help them achieve thei objectives. The

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i entification of specific evelopmental st ategies is essential if UK CR teams a e to continue

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to st ive towa s health ca e excellence.

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Comp ehensive p og amme fee back p ovi e

u ing the application p ocess will help CR

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specialists justify fu the

t aining an

continuing p ofessional

evelopment. Locally,

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p og amme ce tification will imp ove patient ca e th ough continually ising stan a s

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amongst p og ammes maintaining thei ce tifie status. Whilst ce tification will ensu e the

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implementation of minimum stan a s, the th ee-yea ly eview p ocess also aims to

ive

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The UK has a t ack eco

fo

iving excellence in CR. One of the challenges of

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contempo a y health ca e emains se vice inequality. The NCP_CR has the potential to

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ensu e equitable se vice p ovision, imp ove patient outcomes an

elive inte national

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excellence in CR. It is hope that NHS commissione s will eman nothing less than a CR

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se vice with these aspi ations.

NCP_CR is one metho

in which CR p og ammes can

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emonst ate this commitment.

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CONCLUSION

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The National Ce tification P og amme fo Ca iovascula Rehabilitation has been successfully

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launche within the UK. Cu ently it is a volunta y p og amme, but it is hope that commissione s of

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CR will inc easingly equest p og ammes to emonst ate that they meet these minimum stan a s

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in o e to imp ove ca e an outcomes fo people with CVD ove the next few yea s. Ensu ing equity

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of access to CR an imp oving consistency of elive y shoul inc ease long-te m behaviou change

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an cont ibute to a e uction in CVD- elate health inequality. Fo fu the etails an copies of the

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Gui ance fo applicants (which inclu es the full minimum stan a s) please email:

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r Refe ences

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1. Townsen N, Bhatnaga P, Wilkins E, Wick amasinghe K, Rayne .

Ca iovascula

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isease

statistics, 2015

. Lon on: B itish Hea t Foun ation, 2015.d r r d

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2. Public Health Englan Epi emiology an Su veillance team.

The Segment Tool

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f om:http://finge tips.phe.o g.uk/p ofile/segmentr r r .

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3. An e son L, Ol i ge N, Thompson DR, Zwisle A-D, Rees K, a tin N, Taylo RS. Exe cise-base

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ca iac ehabilitation fo co ona y hea t isease: Coch ane systematic eview an meta-analysis.

Jou nal of the Ame ican College of Ca iology

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2016;67(1):1-12.

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4. National Institute fo Health an Ca e Excellence.

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yoca ial infa ction: ca iac ehabilitation an

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p evention of fu the ca iovascula

isease. CG172

. Lon on: NICE, 2013.d

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Ch onic hea t failu e: management of ch onic

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hea t failu e in a ults in p ima y an secon a y ca e, CG108

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6. B itish Association fo Ca iovascula P evention an Rehabilitation.

Stan a s an co e

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components of ca iovascula p evention an

ehabilitation: 2n E ition

. Lon on: BACPR,d 2012.

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Ca iac ehabilitation se vices: commissioning

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gui e

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8. Taylo RS, Dalal H, Jolly K, Zawa a A, Dean SG, Cowie A, No ton RJ. Hombase ve sus cent e-d re-d r

base ca iac ehabilitation.

Coch ane Database of Systematic Reviews

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2015(8).

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9. National Au it of Ca iac Rehabilitation.

Annual statistical epo t 2015

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. Lon on: B itish Hea td r r d

Foun ation, 2015.

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10. Fu ze G, Dohe ty P, G ant-Pea ce C. Development of a UK National Ce tification P og amme fo rd

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Table 1

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The 2016 minimum stan a s fo ce tification of ca iac ehabilitation p og amme elive y an the

data which emonst ates that they a e met. d r r

Minimum stan ad rd Data equi ement r r

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1. The elive y of the seven co e components of CR Name lea fo each componentd d r

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2. An integ ate multi isciplina y team At least th ee p ofessions within the team r r

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3. I entification, efe al an ec uitment of eligible

patient populations

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Offe e at least to p io ity g oups of myoca ial

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infa ction, post evascula isation, hea t failu e

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4. Ea ly initial assessment an eassessment of patient

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% patients with eco e a) baseline assessment

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& b) en of CR assessment is ≥ national me ian

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5. Ea ly p ovision of a CR p og amme with efine r

pathway of ca e

r r rr r Time f om efe al to sta t of CR is ≤ national

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Du ation of CR p og amme is ≥ national me ian

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