Quality indicators in cardiovascular care: The case for cardiac rehabilitation

The drive to improve the quality of healthcare is gaining in momentum. Increasingly, third party payors and other national healthcare organizations are driving this trend by publishing evidence-based practice guidelines, selecting quality of care indicators based on standard criteria, and tracking quality of care "report cards" that compare performance by medical care providers. While referral of patients to a CR program is included in published practice guidelines for the care of persons with CAD, current panels of performance measures do not include CR. However, based on the relevance, soundness, and feasibility of the evidence described in this article, the use of CR services should be included as a standard quality of care indicator for appropriate patients with CAD. The case for such action is presently strong and could be strengthened further by: (1) increasing the level of evidence for CR even further with more multicentered, randomized, controlled trials of CR, particularly in understudied subgroups (women, minorities, the elderly, and in persons undergoing percutaneous intervention or valve surgery), (2) developing feasible methods for assessing the referral and enrollment "bridge" between hospitalization and outpatient CR programs, and (3) continuing to define, promote, and certify standards for the scope and quality of care provided by CR programs. Further work is needed to define the most appropriate performance measure for CR utilization based on currently available evidence.