Nursing Research Days

Research in Action October 22, 2014

Donna Louie RN, BSN, CDE, FPCNA MPHS Cardiac Rehabilitation

October 22, 2014

Evidence-Based Practice Project:

Comparing Disease-Specific and Generic Health Related Quality of Life Tools in Cardiac Rehabilitation

Physical

Social

PsychologicalCV Risk Reduction

Health Related

SF 36 v.1

Generic

Difficult

Time

Aim

Alternative questionnaire:

Easier to administer

Specific to cardiac issues

Sensitive to changes

Used to guide interventions

DATABASE PubMed, Medline, Cinahl

KEY WORDSCardiac Rehabilitation, Quality of Life, Health Related Quality of Life, MacNew, SF 36

Number of Studies: 10

Level of Evidence: 1A-5B

Literature Review

Evidence Appraisal

HRQoL measurement is standard of care in CR.

The SF 36 is appropriate for use in CR patients. There may be advantages to using an additional disease specific tool. (Brown, 2003)

MacNew established as validated disease specific tool. Questions are specific to cardiac disease and sensitive to the treatment of cardiac rehabilitation. (Hofer, 2012)

PICO Question

In patients entering Phase II Cardiac Rehabilitation at Mills Peninsula Health Services, will the self administered MacNew disease-specific HRQoL tool compared to the SF 36 v1 generic HRQoL, require less RN and patient time to complete, improve identification of cardiac symptoms/issues, be perceived as more relevant and identified as the preferred tool?

Test of Change

MarchProtocol

IRB Submission

MayIRB Waiver

Patients completed both toolsRN and Patients rated tools

JuneData Review

Dissemination

Outpatient Therapies Network Manager

Shelly Neufeld, PT, DPT Intake RNs:

Melanie Cirigliano, RN, M.S. Sara Hunt, RN, BSN, CDE Donna Louie RN, BSN, CDE, FPCNA

Administrator, Outcome Data Coordinator, Glue

Susan May AA, EA

Stakeholders

Challenges

IRB requirements and delays

MacNew consent

Time

Communication

Investment in Results

Results: Patient Perceptions

Results: RN Perceptions

MacNew tool:

Reduction in RN and patient administration time.

Preference by RNs and patients.

Relevance to life situation and plan of care.

Reliable cardiac symptom identification and quantification.

Evaluation of Results

Next StepsRe-administer both tools

Evaluate results

Decide on best practice for 2015:

MacNew + PHQ-9 Depression ScreenSF 36 v 2

Jennifer Vickerman M.S., R.N., AOCN, CBCN, Oncology CNS, EBP Fellows Site Coordinator

Lorena Tilton, MSN, RN, Critical Care Clinical Nurse II, EBP Coach

2014 Mills Peninsula Health Services EBP Fellows and Coaches

Diana Hill, RN, CCRC, Clinical Research Manager, Palo Alto Medical Foundation Research Institute

Vicki White, MSN, RN, VP Acute Care Services/CNO

Mills Peninsula Health Services Private Funder

UCSF Center for Nursing Research and Innovation

Acknowledgements

Cepeda-Valery B, Cheong AP, Lee A, Yan BP. Measuring health related quality of life in coronary heart disease: the importance of feeling well. Int J Cardiol. 2011 May 19;149(1):4-9

 Dempster M, Donnelly M, O'Loughlin C. The validity of the MacNew Quality of Life in heart disease questionnaire. Health Qual Life Outcomes. 2004 Jan 22;2:6.

 Höfer S, Lim L, Guyatt G, Oldridge N. The MacNew Heart Disease health-related quality of life instrument: a summary. Health Qual Life Outcomes. 2004 Jan 8;2:3.

 Brown K. A review to examine the use of SF-36 in cardiac rehabilitation. Br J Nurs. 2003 Aug 14-Sep 10;12(15):904-9. Review.

 Abbott AA. Discussion of generic and disease-specific outcome tools for patients in cardiac rehabilitation. Outcomes Manag Nurs Pract. 2000 Apr-Jun;4(2):78-84.

Höfer S, Saleem A, Stone J, Thomas R, Tulloch H, Oldridge N. The MacNew Heart Disease Health-Related Quality of Life Questionnaire in patients with angina and patients with ischemic heart failure. Value Health. 2012 Jan;15(1):143-50.

References

Pinto BM, Dunsiger SI, Farrell N, Marcus BH, Todaro JF. Psychosocial outcomes of an exercise maintenance intervention after phase II cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2013 Mar-Apr;33(2):91-8.

Eder B, Hofmann P, von Duvillard SP, Brandt D, Schmid JP, Pokan R, Wonisch M. Early 4-week cardiac rehabilitation exercise training in elderly patients after heart surgery. J Cardiopulm Rehabil Prev. 2010 Mar-Apr;30(2):85

Mithal M, Granger CV, Naughton JP, Haberl ED, Jones JD. Measuring functional status and health-related quality of life in patients participating in an outpatient phase II cardiac rehabilitation program. Critical Reviews in Physical and Rehabilitation Medicine, 2007 19(2):153-167

American Association for Cardiovascular and Pulmonary Rehabilitation- 2011, Common Clinical Assessment Tools for Outpatient Cardiac Programs

AHA/AACVPR Scientific Statement: Core components of cardiac rehabilitation/secondary prevention programs: a statement for healthcare professionals. Circulation 2000;102:1069-1073; and J Cardiopulm Rehabil 2000;20:310-316.

References

QUESTIONS

Donna Louie RN, BSN, CDE, FPCNAMPHS Cardiac Rehabilitation

louied2@sutterhealth.org