1. Research in Action October 22, 2014

2. 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

3. Physical Social Psychological CV Risk Reduction

5.  Generic  Difficult  Time

6. Aim Alternative questionnaire:  Easier to administer  Specific to cardiac issues  Sensitive to changes  Used to guide interventions

7.  DATABASE PubMed, Medline, Cinahl  KEY WORDS Cardiac Rehabilitation, Quality of Life, Health Related Quality of Life, MacNew, SF 36  Number of Studies: 10  Level of Evidence: 1A-5B Literature Review

8. 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)

9.  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?

10. March Protocol IRB Submission May IRB Waiver Patients completed both tools RN and Patients rated tools June Data Review Dissemination

11.  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

12.  IRB requirements and delays  MacNew consent  Time  Communication  Investment in Results

15.  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

16.  Re-administer both tools  Evaluate results  Decide on best practice for 2015:  MacNew + PHQ-9 Depression Screen  SF 36 v 2

17.  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

18.  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

19.  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

20. QUESTIONS Donna Louie RN, BSN, CDE, FPCNA MPHS Cardiac Rehabilitation louied2@sutterhealth.org