W2eBOP Consensus Paper—A Supporting Statement by the WISCVPR
Outcomes Committee
Committee Members: Barbra Fagan, M.S. (Chair), Menomonee Falls; Kim Beyer, M.S.
Milwaukee; Tracy Herrewig, M.S., Beaver Dam; Kelly Shields, M.S., Stevens Point; Charlie Steil,
M.S., Eau Claire; Carolyn Verhage, R.N., Sheboygan; Mark Vitcenda, M.S., Madison; Lisa
Wenzel, M.S., Madison.
Issue
Measuring outcomes is recognized as an essential component in the evaluation of the
effectiveness of cardiac rehabilitation programs. An outcome is the end result of a process. In
cardiac rehabilitation, it is the measure of a patient’s progress toward a defined goal. Outcomes are
also data collected to demonstrate the efficacy of a program’s procedures. This is an important
aspect of any program in order to justify the value of the program’s services both clinically and
financially. In the changing health care environment, every program will be accountable for their
costs and their processes. Therefore, the movement by cardiac rehabilitation professionals to
measure outcomes is a proactive commitment to high standards and quality programs.
Resources
The Wisconsin Web-Based Outcomes Project Committee (W2eBOP), with support of AACVPR
and WISCVPR, was formed to address and develop a standardized set of cardiac rehabilitation
outcome measures. The Committee is a representation of various regions within the state of
Wisconsin as well as diverse program sizes and experiences.
The Committee determined a general need to focus on collecting data and to move from general,
nonspecific outcome measures to more specific, patient-oriented measures that are able to be
standardized for benchmarking purposes. To this end, the Committee sent a questionnaire to state
members to examine what outcomes are currently being measured and what members felt were
important aspects to be measured.
Implementation Plan
From the results of the survey, the Committee selected outcomes based on several criteria:






Is the measure clinically relevant and meaningful?
Is the measure easily obtained through current practices?
Is the measure controllable?
Does the outcome have the potential to be improved?
Is the measure reproducible?
Can the measure be compared between programs of varying sizes and resources?
The Committee followed outcome guidelines established by AACVPR. Four main domains were
chosen: clinical, behavioral, health and economic (See Table 1).
The Committee also recognized the importance of following patients after discharge from Phase
2 rehabilitation. A set of specific follow-up measures, based on Phase 2 outcomes, was therefore
developed to measure long-term changes in patient outcomes. Lastly, it was felt that the measures
should permit flexibility in allowing programs to determine individual program goals while
maintaining some standardization within the state. The final set of measures was reviewed by the
Committee and sent to the WISCVPR Board of Directors. The project gained the endorsement of
the Board in October, 1999.
Goals/Benefits
These measures are NOT guidelines for individual patient care, or minimal or maximal
standards of care, but should be considered performance measures that allow programs to
compare over time their specific patient populations versus state benchmarks. These
measures should be recognized as an initial attempt at standardizing basic cardiac rehabilitation
outcome measures for the state of Wisconsin. There may be changes to the measures as more
experience is gained. The Committee will assess the data, review the project and report its
progress to the WISCVPR Board of Directors in 2000.
WISCVPR realized the necessity of gathering outcomes consistently using standardized
documentation. After extensive consideration and deliberation, the W2eBOP Committee developed
an electronic format to facilitate this process by using the Internet. Data will be entered on the
WISCVPR web-site and immediate feedback will be generated through printable reports. The
measures will be reported as aggregate data (percent of sample meeting outcome criterion or
average change in a measure) comparing entry and discharge, or in the case of follow-up data,
comparing follow-up and discharge.
Summary
In summary, the W2eBOP Committee is committed to taking a proactive approach to measuring
outcomes and benchmarking program efficiency throughout the state of Wisconsin. A statewide
database is expected to positively impact cardiac rehabilitation through its flexibility and instant
report generation. It is hoped that all cardiac rehabilitation programs in the state, depending on their
abilities and resources, will take part at some level in this process.
Table 1: W2eBOP Cardiac Rehabilitation Outcome Domains
Clinical



Functional
Blood Pressure
Management
Lipid Management
Behavioral





Smoking Cessation
Diet Management
Psychosocial
Exercise Habits
Lifestyle Behavior
Compliance
Health

Quality of Life
Economic



Medical care usage
Events
Financial