Clinical Excellence Queensland · 2019. 12. 8. · The high level of clinical engagement extends beyond clinical practice to working collaboratively with Queensland Health administrators

Clinical Excellence Queensland

Queensland Health

Improvement | Transparency | Patient Safety | Clinician Leadership | Innovation

Statewide Cardiac Clinical NetworkQueensland Cardiac Outcomes Registry

2018 Annual Report Cardiac Rehabilitation Audit

Queensland Cardiac Outcomes Registry 2018 Annual Report

Published by the State of Queensland (Queensland Health), November 2019

This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au

© State of Queensland (Queensland Health) 2019

You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health).

For more information contact:Statewide Cardiac Clinical Network, Queensland Health, GPO Box 48, Brisbane Qld 4001, email [email protected], 15 Butterfield St, Herston Qld 4006, phone 3328 9771 for Statewide Cardiac Clinical Network.

An electronic version of this document is available at: clinicalexcellence.qld.gov.au/priority-areas/ clinician-engagement/statewide-clinical-networks/cardiac

Disclaimer:The content presented in this publication is distrib-uted by the Queensland Government as an informa-tion source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

QCORAnnualReport2018

QCORAnnualReport2018

Contents1 Foreword 1

2 Message from the SCCN Chair 2

3 Introduction 3

4 Executive summary 6

5 Acknowledgements and authors 7

6 Future plans 9

7 Facility profiles 107.1 CairnsHospital 10

7.2 TheTownsvilleHospital 10

7.3 MackayBaseHospital 11

7.4 SunshineCoastUniversityHospital 11

7.5 ThePrinceCharlesHospital 12

7.6 RoyalBrisbaneandWomen’sHospital 12

7.7 PrincessAlexandraHospital 13

7.8 GoldCoastUniversityHospital 13

Cardiac Rehabilitation Audit

1 Message from the QCOR Cardiac Rehabilitation Committee Chair CR 3

2 Key findings CR 4

3 Participating sites CR 5

4 Total referrals CR 74.1 Statewide CR7

4.2 Originofreferrals CR9

4.3 Inpatientreferrals CR10

5 Patient characteristics CR 125.1 Ageandgender CR12

5.2 AboriginalandTorresStraitIslanderstatus CR13

6 Program participation CR 156.1 Preassessmentstage CR15

6.2 Postassessmentstage CR17

6.3 Programoutcomes CR19

6.4 Failuretoparticipate CR23

7 Clinical presentation CR 247.1 Diagnosis CR24

7.2 Mostrecentprocedure CR24

7.3 Riskfactorsandcomorbidities CR25

7.4 Currentmedications CR29

8 Clinical indicators CR 30

9 Declined referrals CR 379.1 Ageandgender CR37

9.2 Diagnosiscategory CR38

9.3 Mostrecentprocedure CR38

9.4 Placeofresidence CR39

10 Conclusions CR 41

References i

Glossary ii

Ongoing initiatives iii

FiguresCardiac Rehabilitation AuditFigure1: MapofQueenslandpublicCRsites CR6Figure2: CumulativetotalCRreferralsbymonth,

2017–2018 CR7Figure3: CRreferralsbyresidentialpostcode CR8Figure4: Proportionofreferralsbyreferralsource CR9Figure5: Proportionofreferralsbyreferralsource

andoutpatientprogramHHS CR10Figure6: NumberofCRinpatientreferralsby

sourceanddestinationHHS/organisation CR11

Figure7: Referralsbypatientgenderandagegroup CR12

Figure8: ProportionofidentifiedAboriginalandTorresStraitIslanderpatientsbyoutpatientHHS CR13

Figure9: ProportionofallCRreferralsbyagegroupandIndigenousstatus CR14

Figure10: ProportionofCRreferralsproceedingtopreassessmentbyHHS CR16

Figure11: ProportionofCRpreassessmentsproceedingtopostassessment CR18

Figure12: Comparisonofpreassessmentandpostassessment6MWTresults CR20

Figure13: ComparisonofpreassessmentandpostassessmentPHQ-4results CR21

Figure14: ComparisonofpreassessmentandpostassessmentAQoL-4Dresults CR22

Figure15: Reasonsfornopreassessmentbeingconducted CR23

Figure16: Smokingstatusbydiagnosiscategory CR25Figure17: Activitylevelbydiagnosiscategory CR25Figure18: BMIcategorybydiagnosiscategory CR26Figure19: Diabetesstatusbydiagnosiscategory CR26Figure20: Highbloodpressurebydiagnosis

category CR26Figure21: Abnormalcholesterolbydiagnosis

category CR27Figure22: Familyhistoryofcardiovascular

diseasebydiagnosiscategory CR27Figure23: Historyofdepressionbydiagnosis

category CR27Figure24: Heartfailurebydiagnosiscategory CR28Figure25: ProportionofHFpatientswithreduced

ejectionfractionbyLVdysfunctionanddiagnosiscategory CR28

Figure26: ProportionofHFpatientswithpreservedejectionfractionbydiagnosiscategory CR28

Figure27: Timelyreferral,assessmentandoveralljourney CR30

Figure28: Timelyreferralsbyreferringhospital CR32Figure29: Timelyassessmentbyoutpatient

program CR34

FigureA: Operationalstructure 3FigureB: QCOR2018infographic 4Figure1: CairnsHospital 10Figure2: TheTownsvilleHospital 10Figure3: MackayBaseHospital 11Figure4: SunshineCoastUniversityHospital 11Figure5: ThePrinceCharlesHospital 12Figure6: RoyalBrisbaneandWomen’sHospital 12Figure7: PrincessAlexandraHospital 13Figure8: GoldCoastUniversityHospital 13

Figure30: TimelyjourneyindicatorbyparticipatingHHS/organisation CR36

Figure31: PatientCRprogramparticipationstatusbyagegroupandgender CR37

Figure32: Proportionofcasesbydiagnosiscategoryandprogramparticipationstatus CR38

Figure33: Proportionofcasesbymostrecentprocedureandprogramparticipationstatus CR38

Figure34: Patientresidentialpostcodebyprogramparticipationstatus CR40

Cardiac Rehabilitation AuditTable1: ParticipatingCRsites CR5Table2: Totalreferralsbyadmissionsource,

2017–2018 CR7Table3: CRreferralsbyremotenessclassification CR8Table4: Referralsourcesbyoutpatientprogram

HHS CR9Table5: CRinpatientreferralsbysourceand

destinationHHS CR10Table6: MedianpatientagebygenderandHHS CR12Table7: PatientagebygenderandIndigenous

status CR14Table8: Totalpreassessmentscompletedby

HHS CR15Table9: Totalpostassessmentscompletedby

HHS CR17Table10: OutlineofCRprogramoutcome

measures CR19Table11: Summaryoflipidvalues CR19Table12: Summaryof6MWTresults CR20Table13: Changein6MWTresults CR20Table14: SummaryofPHQ-4results CR21Table15: ChangeinPHQ-4results CR21Table16: SummaryofAQoL-4Dresults CR22Table17: ChangeinAQoL-4Dresults CR22Table18: Preassessmentsbydiagnosiscategory CR24Table19: Mostrecentprocedurebydiagnosis

category CR24Table20: Currentmedicationsbydiagnosis

category CR29Table21: Cardiacrehabilitationclinicalindicators CR30Table22: TimelyreferralsbyreferringHHS CR31Table23: Summaryofreferralsineligiblefor

timelyassessmentclinicalindicator CR33Table24: Timelyassessmentindicatorby

outpatientHHS CR33Table25: Summaryofreferralsineligiblefor

timelyjourneyclinicalindicator CR35Table26: Timelyjourneyindicatorby

participatingHHS/organisation CR35Table27: Patientage(years)byprogram

participationstatus CR37Table28: Diagnosiscategorybyprogram

participationstatus CR38Table29: Mostrecentprocedurebyprogram

participationstatus CR39Table30: Remotenessclassificationbyprogram

participationstatus CR39

Tables

Supplement: Structural heart disease

QCORAnnualReport2018 Page1

1 ForewordAsDirectorGeneralofQueenslandHealth,Iampleasedto

presenttheQueensland Cardiac Outcomes Registry (QCOR) 2018

Annual Report.TheAnnualReportprovidesdetailedinformation

ontheperformanceofourclinicalcarefor,andoutcomesof,

peoplewithcardiacdisorders.

TheAnnualReportexaminesarangeofclinicalareasincluding

cardiacandthoracicsurgery,cardiacrehabilitation,cardiac

catheterinterventions,electrophysiologyandpacing,andheart

failuresupportservices.Thisyear’sAnnualReportincludes

additionalanalysisofspecificareasofinteresttoenable

examinationofclinicalissuesfacedbypractitionersattheface

ofpatientcare.

TheAnnualReportexemplifieshowQueenslandHealthis

meetingitsobjectivetoenable safe, high quality services.The

resultsshowthatQueenslandersarereceivingsomeofthebest

cardiaccareinthecountry,andoftentheworld.Queensland

Healthiscommittedtoempoweringourpeopletoprovidethe

bestpossiblehealthcare,tobetransparentinourworkand

importantlyuseinformationtoinformandimprovethehealth

outcomesofourpatients.

Thehighlevelofclinicalengagementextendsbeyondclinical

practicetoworkingcollaborativelywithQueenslandHealth

administratorstoimprovetheefficiencyofourorganisation.

Recently,cardiaccliniciansandadministratorscollaboratedand

usedQCORdatatoimprovethepurchasingprocessofclinical

productsresultinginsavingsof$5million.Thesefundswill

nowbeavailableintherelevantHospitalandHealthServicesto

reinvestintopatientcare.

QCORdataallowsustoberesponsivetotheneedsofour

patientsandcommunity.Itisactivelyusedtoinformhowwe

improvetheaccess,equity,safety,efficiencyandeffectiveness

ofourcardiachealthcare.

IwouldliketoacknowledgetheongoingeffortoftheStatewide

CardiacClinicalNetworkanditsmanycliniciansandcolleagues,

whohavecollaboratedtoproducethisAnnualReport.

Dr John Wakefield PSM Director-General Queensland Health

Page2 QCORAnnualReport2018

2 Message from the SCCN Chair Itismypleasuretointroducethe4thQueenslandCardiacOutcomeRegistry(QCOR)AnnualReport.The

activitiesofQCORcontinuetomature,andthisreportgivesusyetanotheropportunitytore-examinethe

reasonsforcontinuingthiswork,aswellasformingastimulustoreinvigorateourefforts.Thechancetoask,

“Whyarewedoingthis?”–alotofeffort,repeatedcommitteemeetings,somelatenights,andoccasional

irritationwithcolleagues,asacounterpoisetotheingrainedcliniciandesiretodotheabsolutebestforevery

patientwecareforandtohavedatatoproveit.Theledgerisstronglytiltedintheaffirmative.

Queenslandisnowacknowledgedashavingsomeofthemostcomprehensivecardiacdatainthecountry,

andthesuccessofthisprogramabsolutelyrestsonthesustainedclinicianparticipationonwhichthe

programmeisbuilt.Everystepfrompatientcare,throughrecordingofdata,tosubmission,reverification

andanalysisisheavilyinvestedbytheclinicians.Thisintensiveparticipationtowardsacommongoalhas

certainlydrawnthecardiaccommunitytogetherandwecanberightlyproudofthecohesivenessofthe

effortstoimprovecareacrossthestate.

Thereportthisyearfurtherextendsimportantelementsofpatientcare–wehaveastrongcollaboration

withQueenslandAmbulanceService(QAS),andnowhaveaccesstoquitecomprehensiveprehospitalcare

includingQASadministeredthrombolysisandoutcomes.InastateaslargeasQueenslanditiscriticalthat

wetracktheseimportantaspectsofcare.Thedocumentationofposthospitalcardiacrehabilitationand

heartfailuremanagementcontinuestoprovideamorecomprehensivepictureextendingthewindowofacute

admissionandwithoutdoubtaddingtothesafetyofouracuteinterventions.

Itisgratifyingtoseethatproceduraloutcomesacrossalloftheparticipatinginstitutionsremainstableand

ofhighquality.

Finally,oneoftheimportantreasonswhichcliniciansoriginallyidentifiedsupportingparticipationinthe

programhascometofruition–thecardiacdataderivedfromQCORhasnowledtospecificinvestmentby

thestategovernmentintheprocessesofcardiaccare.Inthecomingyear,inaninitialinvestmentrollout,

hospitalsinCairnsandTownsvillewillsignificantlyexpandtheiroutreachintoruralandremotecentresin

TorresandCapeandacrosstotheNorthWestHospitalandHealthService.QCORdatahasclearlyprofiled

boththeneedandtheshortfallofcardiacservicesintheseareasandhasledtoarecognitionofour

responsibilitiesfordeliveringsafeandefficacioustreatmentbothforpatientswholiveclosetomajorcentres,

butalsoespeciallyforthosefarremoved.ThisprogrammewillextendtotheremainingHospitalandHealth

Servicesinamulti-yearinvestment.

Again,Igivethankstoalloftheclinicianswhocontinuetoparticipateinthisimportantwork.Inthecoming

year,QCORwillhavethecapacitytoinviteprivatecardiacprovidersinthestatetosubmitdatatoQCOR,so

thatwecanobtainamorecompletepicturebothpublicandprivate,ofcardiacservicesacrossthestate.

AspecialthanksisgiventotheStatewideCardiacClinicalInformaticsUnittechnicalandadministrativestaff

whocontinuetosupplysuperbassistancetotheprogramandwhoaretrulyintegraltothequalityofthe

attachedreport.

Dr Paul Garrahy

Chair

Statewide Cardiac Clinical Network


3 IntroductionTheQueenslandCardiacOutcomesRegistry(QCOR)isanever-evolvingclinicalinformationcollectionwhichenablescliniciansandotherkeystakeholdersaccesstoquality,contextualisedclinicalandproceduraldata.OnthebackgroundofsignificantinvestmentanddirectionfromtheStatewideCardiacClinicalNetwork(SCCN)andundertheauspicesofClinicalExcellenceQueensland,QCORprovidesanalyticsandoverviewforseveralclinicalinformationsystemsanddatabases.Byutilisingextensiveancillarycomplementaryadministrativedatasets,asophisticatedlevelofmulti-purposereportingandinsighthasbeengained.

QCORdatacollectionsaregovernedbybespokeclinicalcommitteeswhichprovideoversightanddirectiontoreportingcontentandanalysisaswellasinformingdecision-makingforfutureendeavours.ThesecommitteesaresupportedbyStatewideCardiacClinicalInformaticsUnit(SCCIU)whoformthebusinessunitofQCOR.AllprocessesandgroupsreporttotheSCCN,whichisfacilitatedbyClinicalExcellenceQueensland.

ThestrengthoftheRegistrywouldnotbepossiblewithoutsignificantclinicianinput.Assistingtomaintainquality,relevanceandcontextthroughQCORcommittees,cliniciansarecontinuallydevelopingandevolvingtheanalysisandfocusofeachspecificgroup.TheSCCIUperformstheroleofcoordinatingtheseindividualQCORcommitteeswhicheachhavetheirindividualdirectionanduniquerequirements.

TheSCCIUprovidethereporting,analysis,anddevelopmentofthemanyclinicalcardiologyandcardiothoracicsurgicalapplicationsandsystemsinuseacrossQueenslandHealth.TheSCCIUalsoprovidesdataqualityandauditfunctionsaswellasexperttechnicalandinformaticsresourcesfordevelopment,maintenanceandcontinualimprovementofspecialisedclinicalapplicationsandrelevantsecondaryuses.

TheSCCIUteamconsistsof:

•MrGrahamBrowne–DatabaseAdministrator • DrIanSmith,PhD–Biostatistician•MrMichaelMallouhi–ClinicalAnalyst • MrWilliamVollbon–Manager

•MrMarcusPrior–InformaticsAnalyst • MrKarlWortmann–ApplicationDeveloper

This2018QCORreportnowincludesatotalof6clinicalaudits.TheadditionofthethoracicsurgeryauditreportcomplementstheexistingcardiacsurgeryreporttoenableaclearerpictureoftheworkundertakenbycardiacandthoracicsurgeonsinQueensland.Thisworkreflectseffortsinthisspaceandthehighlightsthevastpatientcohortthatareencounteredbycliniciansworkinginthisspecialty.ItiswiththiscontinualdevelopmentandevolutionofclinicalreportingmaturitythatQCORhopestofurthersupportcardiothoracicclinicalinformaticsintothefuture.

Tier 4: Steering CommitteeStatewide Cardiac Clinical Network

Tier 3: Executive DirectorHealthcare Improvement Unit

Tier 2: Deputy Director GeneralClinical Excellence Division

Tier 1: Director General

QCOR Business UnitSCCIU

QCORAdvisory Committee

QCORElectrophysiology

and PacingCommittee

QCORInterventional

CardiologyCommittee

QCORCardiac

RehabilitationCommittee

QCORHeart Failure

Committee

QCORCardiac Imaging

Committee

QCORCardiothoracic

SurgeryCommittee

Figure A: Operational structure


11% Hospital spending on cardiovascular disease

1 in 5admitted to hospital†

766,000 aged 65 years or older†

15% of total disease burden

is caused bycardiovascular disease†

16%Coronary heart diseaseis the leading cause of

death

>5 millionpopulation*

2018 Activity at a GlanceQueensland Cardiac Outcomes Registry

Thoracic Surgery Audit Interhospital transfer for coronary intervention review

What’s new?

Continuing our work

Clinical indicator progress

Case and patient volumesThe health of Queenslanders

Electrophysiology and pacing clinical indicators Cardiac rehabilitation patient outcome measures

Thrombolysis for STEMI analysis Body mass index in cardiac surgery investigation

Data linkage opportunities Structural heart disease application

National registry alignment Cardiac outreach application

Clinical indicator review ECG Flash project

Reference 1” please use an asterisk glyph.Reference 2 = dagger glyph,Reference 3 = double dagger

Reference 4 = paragraph symbol

4,867percutaneous coronary

interventions

11,723cardiac rehabilitation

referrals

850adult thoracic surgeries

2,384adult cardiac surgeries

4,878new heart failure support

services referrals

148transcatheter aortic valve replacement procedures

95%of cardiac

rehabilitation referrals within 3 days of

discharge

0.3%procedural tamponade rate for cardiac device and electrophysiology

procedures

85 minsmedian first

diagnostic ECG to reperfusion time for

primary PCI

0.9%mortality rate for

coronary artery bypass surgery at 30 days

92% of patients referred to a heart failure support service on an ACEI or

ARB at discharge

3,136cardiac electronic

implantable device procedures

401structural heart disease

interventions

4,474electrophysiology and

pacing procedures

23% have untreated

high blood pressure

11% smoke daily†

4.6% Aboriginal and Torres Strait

Islander population‡

31% have untreated

high total cholesterol

28%of all deaths due

to cardiovascular disease

4.8% have diabetes§

2 in 3 are overweight

or obese†

63% are sufficiently active†

Figure B: QCOR 2018 infographic


11% Hospital spending on cardiovascular disease

1 in 5admitted to hospital†

766,000 aged 65 years or older†

15% of total disease burden

is caused bycardiovascular disease†

16%Coronary heart diseaseis the leading cause of

death

>5 millionpopulation*

2018 Activity at a GlanceQueensland Cardiac Outcomes Registry

Thoracic Surgery Audit Interhospital transfer for coronary intervention review

What’s new?

Continuing our work

Clinical indicator progress

Case and patient volumesThe health of Queenslanders

Electrophysiology and pacing clinical indicators Cardiac rehabilitation patient outcome measures

Thrombolysis for STEMI analysis Body mass index in cardiac surgery investigation

Data linkage opportunities Structural heart disease application

National registry alignment Cardiac outreach application

Clinical indicator review ECG Flash project

Reference 1” please use an asterisk glyph.Reference 2 = dagger glyph,Reference 3 = double dagger

Reference 4 = paragraph symbol

4,867percutaneous coronary

interventions

11,723cardiac rehabilitation

referrals

850adult thoracic surgeries

2,384adult cardiac surgeries

4,878new heart failure support

services referrals

148transcatheter aortic valve replacement procedures

95%of cardiac

rehabilitation referrals within 3 days of

discharge

0.3%procedural tamponade rate for cardiac device and electrophysiology

procedures

85 minsmedian first

diagnostic ECG to reperfusion time for

primary PCI

0.9%mortality rate for

coronary artery bypass surgery at 30 days

92% of patients referred to a heart failure support service on an ACEI or

ARB at discharge

3,136cardiac electronic

implantable device procedures

401structural heart disease

interventions

4,474electrophysiology and

pacing procedures

23% have untreated

high blood pressure

11% smoke daily†

4.6% Aboriginal and Torres Strait

Islander population‡

31% have untreated

high total cholesterol

28%of all deaths due

to cardiovascular disease

4.8% have diabetes§

2 in 3 are overweight

or obese†

63% are sufficiently active†

* AustralianBureauofStatistics.Regionalpopulationgrowth,Australia,2017-2018.Cat.no.3218.0.ABS:Canberra;2019

† QueenslandHealth(2018).ThehealthofQueenslanders2018.ReportoftheChiefHealthOfficerQueensland.Brisbane.QueenslandGovernment

‡ AustralianBureauofStatistics.EstimatesofAboriginalandTorresStraitIslanderAustralians,June2016.Cat.no3238.055001.ABS:Canberra;2018

§ DiabetesAustralia.Statestatisticalsnapshot:Queensland.Asat30June2018;2018


4 Executive summaryThisreportencompassesproceduresandcasesfor8cardiaccatheterisationlaboratories(CCL)andelectrophysiologyandpacing(EP)facilitiesand5cardiothoracicsurgeryunitsoperatingacrossQueenslandpublichospitals.Italsoincludesreferralstoclinicalsupportandrehabilitationservicesforthemanagementofheartdiseaseincluding22heartfailuresupportservicesand55cardiacrehabilitationoutpatientfacilities.

•15,436diagnosticorinterventionalcaseswereperformedacrossthe8publiccardiaccatheterisationlaboratoryfacilitiesinQueenslandhospitals.Ofthese,4,867involvedpercutaneouscoronaryintervention(PCI).

•PatientoutcomesfollowingPCIremainencouraging.The30daymortalityratefollowingPCIwas1.9%,andofthe94deathsobserved,74%wereclassedaseithersalvageoremergencyPCI.

•InanalysisforpatientswithSTEMI,themediantimefromFdECGtoreperfusionandarrivalatPCIfacilitytoreperfusionwasobservedat85minutesand42minutes.Thiscomparesfavourablytoresultsforpreviousyearsandinternationally.

•Acrossthefoursiteswithacardiacsurgeryunit,atotalof2,384caseswereperformedincluding1,414CABGand1,005valveprocedures.

•Asinpreviousyears,observedratesforcardiacsurgerymortalityandmorbidityareeitherwithintheexpectedrangeorbetterthanexpected,dependingontheriskmodelusedtoevaluatetheseoutcomes.Onceagaintheexceptionwastherateofdeepsternalwoundinfection.

•TheCardiacSurgeryAuditincludesafocusedsupplementonobesityincardiacsurgery.Thisreporthighlightstheincreasedrateofpost-operativemorbidityandmortalityforpatientswithahigherBMI(>30kg/m2).

•Thefivepublichospitalsprovidingthoracicsurgeryservicesin2018performedatotalof850cases.Almostone-third(30%)ofsurgeriesfollowedapreoperativediagnosisofprimarylungcancerorpleuraldisease(33%).ThisisthefirstQCORAnnualReporttoexaminethoracicsurgery,andthiswillbeexpandedinfutureyears.

•Atthe8publicEPsites,atotalof4,474caseswereperformed,whichincluded3,136cardiacdeviceproceduresand1,061electrophysiologyprocedures.ThisauditincludesexpandedreportingaroundclinicalindicatorsforEPcases.

•ThisElectrophysiologyandPacingAuditidentifiedamedianwaittimeof81daysforcomplexablationprocedures,and33daysforelectiveICDimplants.

•Therewereatotalof11,723referralstooneofthe55publiccardiacrehabilitationservicesin2018.Mostreferrals(77%)followedanadmissionatapublichospitalinQueensland.

•ThevastmajorityofreferralstoCRwerecreatedwithinthreedaysofthepatientbeingdischargedfromhospital(95%),whileoverhalfofpatientswentontocompleteaninitialassessmentbyCRwithin28daysofdischarge(59%).

•Therewere4,878newreferralstoaheartfailuresupportservicein2018.Clinicalindicatorbenchmarkswereachievedfortimelyfollow-upofreferrals,andprescriptionofangiotensin-converting-enzymeinhibitor(ACEI)orangiotensinIIreceptorblockers(ARB)andappropriatebetablockersasperclinicalguidelines.


5 Acknowledgements and authorsThiscollaborativereportwasproducedbytheSCCIU,auditleadforQCORforandonbehalfoftheStatewideCardiacClinicalNetwork.

TheworkofQCORwouldnotbepossiblewithoutthecontinuedsupportandfundingfromClinicalExcellenceQueensland.Thispublicationdrawsontheexpertiseofmanyteamsandindividuals.Inparticular,theassistanceoftheStatisticalServicesBranch,HealthcareImprovementUnitandQueenslandAmbulanceServiceeachmakesignificantcontributionstoensurethesuccessoftheprogram.MetroNorthHospitalandHealthServicearealsorecognisedthroughtheirstakeinsupportingandhostingtheSCCIUoperationalteam.

Furthermore,thetirelessworkofclinicianswhocontributeandcollatequalitydata,aspartofprovidingqualitypatientcare,ensurescredibleanalysisandmonitoringofthestandardofcardiacservicesinQueensland.Thefollowingprovidedwritingassistancewiththisyear’sreport:

Interventional CardiologyDr Sugeet Baveja •TheTownsvilleHospitalDr Niranjan Gaikwad•ThePrinceCharlesHospitalDr Christopher Hammett•RoyalBrisbaneandWomen’sHospitalA/Prof Richard Lim•PrincessAlexandraHospitalDr Rohan Poulter•SunshineCoastUniversityHospitalA/Prof Atifur Rahman•GoldCoastUniversityHospitalDr Shantisagar Vaidya•MackayBaseHospitalDr Gregory Starmer (Chair)•CairnsHospital

Queensland Ambulance ServiceDr Tan Doan, PhDMr Brett Rogers

Cardiothoracic SurgeryDr Anil Prabhu•ThePrinceCharlesHospitalDr Andrie Stroebel•GoldCoastUniversityHospitalDr Morgan Windsor•RoyalBrisbaneandWomen’sHospital•ThePrinceCharlesHospitalDr Sumit Yadav•TheTownsvilleHospitalDr Christopher Cole (Chair)•PrincessAlexandraHospital

Electrophysiology and PacingMr John Betts•ThePrinceCharlesHospitalMr Anthony Brown•SunshineCoastUniversityHospitalMr Andrew Claughton•PrincessAlexandraHospitalDr Naresh Dayananda•SunshineCoastUniversityHospitalDr Russell Denman•ThePrinceCharlesHospitalMr Braden Dinham•GoldCoastUniversityHospitalMs Sanja Doneva•PrincessAlexandraHospitalMr Nathan Engstrom•TheTownsvilleHospitalMs Kellie Foder•RoyalBrisbaneandWomen’sHospitalDr Bobby John•TheTownsvilleHospitalDr Paul Martin•RoyalBrisbaneandWomen’sHospitalMs Sonya Naumann•RoyalBrisbaneandWomen’sHospitalDr Kevin Ng•CairnsHospitalDr Robert Park•GoldCoastUniversityHospitalA/Prof John Hill (Chair)•PrincessAlexandraHospital


Cardiac RehabilitationMs Michelle Aust•SunshineCoastUniversityHospitalMs Maura Barnden •MetroNorthHospitalandHealthServiceMr Gary Bennett•HealthContactCentreMs Jacqueline Cairns•CairnsHospitalMs Yvonne Martin•ChronicDiseaseBrisbaneSouthDr Johanne Neill•IpswichHospitalMs Samara Phillips•StatewideCardiacRehabilitationCoordinatorMs Deborah Snow•GoldCoastHospitalandHealthServiceMs Natalie Thomas•SouthWestHospitalandHealthServiceMr Stephen Woodruffe (Chair)•WestMoretonHospitalandHealthService

Heart Failure Support ServicesMs Kimberley Bardsley•QueenElizabethIIHospitalMs Tina Ha •PrincessAlexandraHospitalMs Helen Hannan•RockhamptonHospitalMs Annabel Hickey•StatewideHeartFailureServicesCoordinatorDr Rita Hwang, PhD•PrincessAlexandraHospitalMs Alicia McClurg•WestMoretonHospitalandHealthServiceDr Kevin Ng•CairnsHospitalMs Robyn Peters•PrincessAlexandraHospitalMs Serena Rofail •RoyalBrisbaneandWomen’sHospitalDr Yee Weng Wong•ThePrinceCharlesHospitalA/Prof John Atherton (Chair)•RoyalBrisbaneandWomen’sHospital

Statewide Cardiac Clinical Informatics UnitMr Michael MallouhiMr Marcus Prior Dr Ian Smith, PhDMr William Vollbon


6 Future plansContinualprogresswithexpandedanalysesandusesofclinicaldatahasbeenafocusforQCORin2018.Thisisevidentthroughnewreportelementsencompassingthoracicsurgeryandextendedexaminationofpatientsundergoingthrombolysisformyocardialinfarction.Similarly,obesityandcardiacsurgeryhavebeenexaminedandhaveunveiledkeyfindingsthatarehighlyrelevantgiventheincreasingincidenceofobesitywithinthegeneralpopulation.Intendingtoprovideclinicallyrelevantanalysis,thefutureworkofQCORisexciting.

TheutilisationoflinkagedataprovidedbyadministrativedatasetscontinuestoenableandassistQCORdatacollections.Thesedataenableinformationfromdifferentsourcestobebroughttogethertocreateanew,richerdataset.ExamplesoffutureopportunitiesfortheuseofsupplementarydatasetsaremedicationdetailfromdischargesummariesandpathologyinvestigationsundertakenwithinpublicQueenslandfacilities.Withaccesstotheseexpandeddatacollections,thereareopportunitiestobeseizedacrossmanyfrontsincludingenhancedriskadjustmentoptions,expandedclinicalindicatorprogramsandstreamlinedparticipationinnationalregistryactivities.Furthermore,thiswillenableefficienciesindatacollectionswhereelementsareeithernotavailableorpracticalforcollectionatthepoint-of-care,andtherebyreduceduplicationofentryacrossclinicalsystems.

OpportunitiesexisttobetterintegrateQCORclinicalapplicationswithenterprisesystemssuchastheacclaimedQueenslandHealthapplication,TheViewer.Itisenvisagedthatcardiacrehabilitationreferralsandassessmentformswillbeincorporatedwithinthepatientrecord,alongwithprocedurereportsgeneratedbytheupcomingQCORstructuralheartdiseaseapplication.ThesedevelopmentsaresettocomplementtheexistingreportsharingfunctionalitypresentwithintheQCORelectrophysiologysystem.Furtheropportunitieshavebeenflaggedacrosstheheartfailuresupportservicesandcardiothoracicsurgeryspacetoenhancetheseapplicationstomeetthebespokerequirementsoftheclinicalspecialtyareas.ByembracingopportunitiestosharevaluableclinicaldatakeptinvariousQCORsystems,investmentinQCORapplicationswillbefurtherrealisedandvalued.

Continualdevelopment,revision,andoptimisationofclinicalindicatorprogramsisessentialtotheongoingrelevanceoftheRegistry.QCORwillcontinuetocollaboratewithexpertsinallclinicaldomainstoexpandthescopeofourexistinganalyses.Thiswillbeundertakenwithaviewtomaintainandenhancethequalityofreportingandimprovethetimelinessandrelevanceoftheinformationprovidedforclinicalleads.Suchareaswherereportingwillbeenhancedfornextyear’sAnnualReportinclude:

•Timetoangiographyforpatientsreceivingthrombolysis

•Expandedradiationsafetyanalysesfordiagnosticandinterventionalcardiology

•Reviewofriskadjustmentmodelsforinterventionalcardiology

•EuroSCOREIIriskadjustmentforcardiacsurgerypatients

•MRAprescriptionratesforHFrEFpatients

•CRreferralsratesfollowingcardiacintervention

QCORisactivelyinvestigatingopportunitieswithinseveralareasincludingtheimplementationofnewpatient-reportedoutcomesandquality-of-lifemeasuresandrealisingfurtherefficienciesconcerningstatewideprocurementofmedicaldevices.NewareasofresearchandresearchpartnersandopportunitiestocontributetoworksunderwayacrossQueenslandHealth,andatanationallevel,arecontinuallybeingpursuedandengaged.


7 Facility profiles

7.2 The Townsville Hospital

Figure 2: The Townsville Hospital

•ReferralhospitalforCairnsandHinterlandandTorresandCapeHospitalandHealthServices,servingapopulationofapproximately280,000

•PublictertiarylevelinvasivecardiacservicesprovidedatCairnsHospitalinclude:

•Coronaryangiography

•Percutaneouscoronaryintervention

•Structuralheartdiseaseintervention

•ICD,CRTandpacemakerimplantation

•ReferralhospitalforTownsvilleandNorthWestHospitalandHealthServices,servingapopulationofapproximately295,000

•PublictertiarylevelinvasivecardiacservicesprovidedatTheTownsvilleHospitalinclude:




•Electrophysiology


•Cardiothoracicsurgery

7.1 Cairns Hospital

Figure 1: Cairns Hospital


7.4 Sunshine Coast University Hospital

Figure 4: Sunshine Coast University Hospital

•ReferralhospitalforMackayandWhitsundayregions,servingapopulationofapproximately182,000

•PublictertiarylevelinvasivecardiacservicesprovidedatMackayBaseHospitalinclude:



•Pacemakeranddefibrillatorimplants

•ReferralhospitalforSunshineCoastandWideBayHospitalandHealthServices,servingapopulationofapproximately563,000

•PublictertiarylevelinvasivecardiacservicesprovidedatSunshineCoastUniversityHospitalinclude:






7.3 Mackay Base Hospital

Figure 3: Mackay Base Hospital


7.6 Royal Brisbane and Women’s Hospital

Figure 6: Royal Brisbane and Women’s Hospital

•ReferralhospitalforMetroNorth,WideBayandCentralQueenslandHospitalandHealthServices,servingapopulationofapproximately900,000(sharedreferralbasewiththeRoyalBrisbaneandWomen’sHospital)

•PublictertiarylevelinvasivecardiacservicesprovidedatThePrinceCharlesHospitalinclude:







•Heart/lungtransplantunit

•Adultcongenitalheartdiseaseunit

•ReferralhospitalforMetroNorth,WideBayandCentralQueenslandHospitalandHealthServices,servingapopulationofapproximately900,000(sharedreferralbasewithThePrinceCharlesHospital)

•PublictertiarylevelinvasivecardiacservicesprovidedatTheRoyalBrisbaneandWomen’sHospitalinclude:






•Thoracicsurgery

7.5 The Prince Charles Hospital

Figure 5: The Prince Charles Hospital


7.8 Gold Coast University Hospital

Figure 8: Gold Coast University Hospital

•ReferralhospitalforMetroSouthandSouthWestHospitalandHealthServices,servingapopulationofapproximately1,000,000

•PublictertiarylevelinvasivecardiacservicesprovidedatthePrincessAlexandraHospitalinclude:







•ReferralHospitalforGoldCoastandnorthernNewSouthWalesregions,servingapopulationofapproximately700,000

•PublictertiarylevelinvasivecardiacservicesprovidedattheGoldCoastUniversityHospitalinclude:







7.7 Princess Alexandra Hospital

Figure 7: Princess Alexandra Hospital


Cardiac Rehabilitation Audit

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QCORAnnualReport2018 PageCR3

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1 Message from the QCOR Cardiac Rehabilitation Committee Chair

ItismysincerepleasuretointroducethesecondQCORCardiacRehabilitationAudit.Thisisthefirstannual

reporttodocumentafullyearofdatacollectionforourstatewidecardiacrehabilitationservices.The

previousauditreportedjusta6monthperiodofdatacollectionfromJulytoDecember2017,whereas

thisreportdocumentsafullcalendaryearofdatacollectionthrough2018.Thiswillalsobeourfirst

opportunitytocomparedatacollectionyeartoyear.Also,whilethe2017reportdocumentedsolelyadmission

(preassessment)data,this2018reportwillpresentsomelimitedpostprogramdata.Thiswillbeourfirst

insightintotheeffectivenessofcardiacrehabilitation,atalocallevelandonastatewidescale.

Datacollectionhascentredaroundtheinclusionofserviceperformancemeasures(timelyreferral,timely

assessment)andpatientclinicalindicators(e.g.medications,riskfactors,exercisetolerance,mentalhealth)

onbothadmissionandcompletionofcardiacrehabilitationprograms.

Thisreportpresentsthatatotalof11,723patientswerereferredtooneofthe53cardiacrehabilitation

sitesaccessiblethroughQueenslandHealthin2018.Ofthese,95%ofpatientswerereferredtocardiac

rehabilitationinatimelymanner(within3days)and62%wereassessedwithin28daysofreferral.Analysis

hashighlightedthehigherincidenceofcardiovasculardiseaseintheAboriginalandTorresStraitIslander

populationthroughtheincreasedrateofreferraltocardiacrehabilitation.Themedianageofthesepatients

is10yearsyoungerthanthatofnon-IndigenousQueenslanders,furtherreflectingtheimpactsonthis

populationgroup.

Iwouldsincerelyliketothankthehardworkingnursesandalliedhealthprofessionalsresponsibleforthe

hoursofdataentryinvolvedincollectingthisinformation.Thistoolistheenvyofmanyofoursisterstate

departmentsofhealth.TheQCORCardiacRehabilitationtoolisuniqueinthatitisapoint-of-careassessment

toolanddatacollectiondeviceinone,witheducationcapabilitiesbuilt-in.Iamveryproudoftheeffortsof

ourcardiacrehabilitationclinicians,thecommitteeresponsibleforoverseeingthecollectionofthisdataand

verythankfulfortheongoingsupportoftheSCCIUteam.

Stephen Woodruffe

Chair

QCOR Cardiac Rehabilitation Committee

PageCR4 QCORAnnualReport2018

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2 Key findingsThissecondQCORCardiacRehabilitation(CR)Auditexaminesreferralstooneof55participatingpublicoutpatientCRsitesfor2018.Keyfindingsinclude:

•Atotalof11,723referralsweremadetopublicCRsitesacrossQueensland.

•Approximately77%ofallreferralsoriginatedfromaninpatientsetting,while14%ofreferralsoriginatedfromoutsideofQueenslandHealth.

•Malepatientsaccountedfor70%ofallreferralstoCR.

•Approximately15%ofallreferralswereforpatientsaged65yearsto69yearsofage.

•Themedianageofallpatientswas66years.TherewasconsiderablevariationbetweenAboriginalandTorresStraitIslanderpatients(56years)andnon-Indigenouspatients(66years).

•ThetotalproportionofAboriginalandTorresStraitIslanderpatientswas6.3%.LargegeographicalvariancewasnotedwithNorthQueenslandsiteshavingasignificantlyhigherproportionofAboriginalandTorresStraitIslanderpatients.

•Overall,65%ofreferralshadapreassessmentdiagnosisofischaemicheartdisease.

•Atpreassessment,79%ofpatientswereclassedasbeinganunhealthyweightwith38%classedasoverweight,36%obeseand5%morbidlyobese.

•Only36%ofpatientswererecordedasbeingsufficientlyactiveatpreassessment.

•Completionofatimelyreferral(within3daysofdischargefromhospital)wasachievedin95%ofcases.

•Atimelyoveralljourneyoccurredin59%ofcases(referredwithin3daysofdischargeandassessedbyCRprogramwithin28daysofdischarge).

•Intotal,40%ofpatientswhocompletedapreassessmentcontinuedCRtothecompletionofapostassessment.


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3 Participating sitesIn2018,therewere60publicCRsitesoperatedacross14HospitalandHealthServices(HHS)andoneQueenslandHealthdivision(HealthSupportQueensland)locatedinruralandmetropolitanQueensland.Ofthese,55participatedinQCOR.

Table 1: Participating CR sites

Legend:◉Engagedandcontributing◍Partiallycontributing(<50%ofreferrals)○Notcontributing

HHS/Organisation CR program Locations 2017 2018CairnsandHinterland CairnsOutpatientCRProgram Cairns ◉ ◉

CassowaryAreaCR Innisfail,Tully ◉ ◉TablelandsCR Atherton,Mareeba ◉ ◉MossmanCRandPreventionProgram Mossman ◉ ◉

CentralQueensland CommunityHealthCR Gladstone ◉ ◉BiloelaCRProgram Biloela ◉ ◉CROutpatientProgram Rockhampton,CapricornCoast ◉ ◉

CentralWest LongreachandCentralWestCRProgram Longreach ◉ ◉Blackall* - ◉

DarlingDowns ToowoombaHospitalHeartCare Toowoomba ◉ ◉WarwickCRService Warwick ◉ ◉Chinchilla-MilesCRService Chinchilla,Miles ◉ ◉Dalby-TaraCRService Dalby,Tara ◉ ◉KingaroyHospitalSouthBurnettCR Kingaroy ◉ ◉GoondiwindiCR Goondiwindi ○ ○StanthorpeHealthCRProgram Stanthorpe ○ ○

GoldCoast GoldCoastHeartHealthService Robina ◉ ◉HSQ† COACHProgram HealthContactCentre ◉ ◉Mackay MackayHeartHealthService Mackay ◉ ◉

MackayRuralDistrictCR Proserpine ◉ ◍Bowen ○ ○

MetroNorth ComplexChronicDisease Caboolture,Chermside,NorthLakes,Redcliffe

◉ ◉

MetroSouth BaysideCRProgram Redland ◉ ◉BrisbaneSouthHeartSmart EightMilePlains,Inala ◉ ◉Logan-BeaudesertCRService BrownsPlains ◉ ◉PAHHeartRecoveryProgram PrincessAlexandraHospital ◉ ◉

NorthWest MountIsaCRProgram MountIsa ◉ ◉SouthWest SouthWestCRServices Charleville,Roma ◉ ◉

StGeorge* - ◉SunshineCoast CardiacRehab Caloundra,Gympie,Maroochydore,

Nambour,Noosa◉ ◉

Townsville TownsvilleCROutpatientProgram Townsville ◉ ◉InghamCROutpatientProgram Ingham ◉ ◍ChartersTowersCommunityHealthCR ChartersTowers ○ ◍AyrHealthService Ayr ○ ○HughendenCRProgram Hughenden ○ ○

WestMoreton IpswichandWestMoretonCR Ipswich,Boonah,Esk,Gatton,Laidley

◉ ◉

WideBay FraserCoastCR HerveyBay,Maryborough ◉ ◉WideBayRuralandAlliedHealth* Biggenden,Eidsvold,Gayndah,

Mundubbera- ◉

* NewCRservicecommencingin2018

† HealthSupportQueensland


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Logan-Beaudesert

Eight Mile Plains

Maroochydore

Gold Coast

Caboolture

Chermside

Caloundra

Kingaroy

Redcliffe

Bayside

Boonah

Gympie

LaidleyGatton

Noosa

Esk

Ipswich

Charters Towers

Capricorn Coast

Goondiwindi

Hervey Bay

Hughenden

Stanthorpe

Proserpine

Longreach

Charleville

Townsville

Gladstone

Mossman

Mackay

Innisfail

Ingham

Bowen

Biloela

Mt Isa

Roma

Tully

Tara

Ayr

DalbyChinchilla-Miles

Maryborough

Rockhampton

Warwick

Princess Alexandra HospitalCOACH

InalaToowoomba

North Lakes

Nambour

AthertonMareeba

Cairns

Figure 1: Map of Queensland public CR sites


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4 Total referrals

4.1 StatewideThevolumeofCRreferralsenteredintoQCORexpandedthrough2018toinclude11,723newreferralsfortheyear,bringingtheoveralltotaltoover18,000referralssincethesystemwaslaunchedandCRdatacollectioncommencedinJuly2017(Figure2).

TheinitialimplementationoftheQCORCRmodulehadaspecificfocustowardspatientsdischargedfromapublichospital.Referralpatternshavecontinuedtobeconsistentthroughoutthecalendaryearof2018,withthemajorityofreferrals(77%)originatingfromaninpatientsetting.

2017 2018

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec0

5,000

10,000

15,000

20,000

Legend: Inpatient Outpatient Non Queensland Health

Figure 2: Cumulative total CR referrals by month, 2017–2018

Table 2: Total referrals by admission source, 2017–2018

Referral origin 2017 %

2018 %

Inpatient 78.0 76.5Outpatient 9.6 10.0NonQueenslandHealth 12.5 13.5


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Patientswerelocatedacrossawidegeographicalareawiththemajorityresidinginpopulationcentresalongtheeasternseaboard.Justunderhalf(49%)ofallpatientswereresidinginmajorcities,andtheremainderinregionalandremoteareasofQueensland.Thisreflectsthedecentraliseddistributionofthepopulationwithinthestate.

Itisimportanttonotethatreferralsforpatientsresidinginterstateoroverseasarenotgenerallyaccepted.Theinclusionofthesereferralsisreflectiveoflocalsiteprocessesandmayalsovarybasedonavailableresources.WhilesomesitesleverageQCORtomaintainarecordofoverallreferralvolumes,othersutilisedifferentprocessesandassuchmaynotrepresentallinpatientactivitywhichdoesnotleadtoareferraltoaQueenslandpublicCRprogram.

Figure 3: CR referrals by residential postcode

Table 3: CR referrals by remoteness classification

Remoteness classification* %MajorCitiesofAustralia 49.3InnerRegionalAustralia 30.4OuterRegionalAustralia 16.8RemoteAustralia 1.3VeryRemoteAustralia 2.2ALL 100.0* ClassifiedbyAccessibilityandRemotenessIndexofAustralia


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4.2 Origin of referralsThemajorityofreferrals(77%)originatedfromaninpatientsetting,withsmallerproportionsofreferralsflowingtoCRfromanoutpatientsetting(10%)andoutsideofQueenslandHealth(14%).

TherewereconsiderablevariationsacrossparticipatingHHSintheproportionofreferralsfromexternalsources,whichrangedfrom1%to31%.Thisindicatesnotallsitesareenteringdetailsforpatientsreferredfromgeneralpractitioners,privatehospitalsorexternalspecialists.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Inpatient

Outpatient

External

Figure 4: Proportion of referrals by referral source

Table 4: Referral sources by outpatient program HHS

HHS/division Total referrals n

Inpatient* n (%)

Outpatient* n (%)

External n (%)

CairnsandHinterland 725 598(82.5) 53(7.3) 74(10.2)CentralQueensland 1,368 909(66.4) 233(17.0) 226(16.5)CentralWest 39 19(48.7) 20(51.3) –DarlingDowns 474 333(70.3) 41(8.6) 100(21.1)GoldCoast 1,598 1,247(78.0) 189(11.8) 162(10.1)HealthSupportQueensland 1,567 1,389(88.6) 144(9.2) 34(2.2)Mackay 298 247(82.9) 47(15.8) 4(1.3)MetroNorth 1,175 825(70.2) 82(7.0) 268(22.8)MetroSouth 1,647 1,194(72.5) 98(6.0) 355(21.6)NorthWest 79 56(70.9) 20(25.3) 3(3.8)SouthWest 45 26(57.8) 10(22.2) 9(20.0)SunshineCoast 969 867(89.5) 37(3.8) 65(6.7)Townsville 624 507(81.3) 98(15.7) 19(3.0)WestMoreton 828 510(61.6) 65(7.9) 253(30.6)WideBay 287 237(82.6) 40(13.9) 10(3.5)Statewide 11,723 8,964 (76.5) 1,177 (10.0) 1,582 (13.5)* IncludesreferralsfromaQueenslandHealthpublicfacility


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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Cairns and Hinterland

Central Queensland

Central West

Darling Downs

Gold Coast

Health Support Queensland

Mackay

Metro North

Metro South

North West

South West

Sunshine Coast

Townsville

West Moreton

Wide Bay

Statewide

Legend: Inpatient Outpatient Non Queensland Health

Figure 5: Proportion of referrals by referral source and outpatient program HHS

4.3 Inpatient referrals Forreferralsoriginatingfromaninpatientsetting,thelargestreferrerwasMetroNorthHospitalandHealthServicewhichaccountedforalmostone-quarter(24%)ofreferrals.ThelargestCRprogramwastheCOACHProgram(HealthSupportQueensland)whichreceived16%ofallinpatientreferrals.

Table 5: CR inpatient referrals by source and destination HHS

HHS/organisation Outgoing inpatient referrals n (%)

Incoming inpatient referrals n (%)

CairnsandHinterland 500(5.6) 598(6.7)CentralQueensland 724(8.1) 909(10.1)CentralWest 3(<0.1) 19(0.2)DarlingDowns 108(1.2) 333(3.7)GoldCoast 1,251(14.0) 1,247(13.9)HealthSupportQueensland – 1,389(15.5)Mackay 240(2.7) 247(2.8)MaterHealthServices 113(1.3) –MetroNorth 2,178(24.3) 825(9.2)MetroSouth 1,748(19.5) 1,194(13.3)NorthWest 2(<0.1) 56(0.6)

SouthWest – 26(0.3)SunshineCoast 826(9.2) 867(9.7)Townsville 957(10.7) 507(5.7)WestMoreton 208(2.3) 510(5.7)WideBay 106(1.2) 237(2.6)Statewide 8,964 (100.0) 8,964 (100.0)


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TheflowofinpatientreferralsfromtheoriginatingHHSororganisation(acutesite)totheCRoutpatientprogramHHSisillustratedinFigure6.ThemajorityofinpatientreferralsremainedwithintheoriginatingHHS,thoughtherewassomevariationnoted.

ItshouldbehighlightedthattherearenooutpatientprogramsforMaterHealthServices,andconverselyHealthSupportQueenslandprovidesanoutpatientserviceonly.

Cairns and Hinterland: 500Cairns and Hinterland: 598

Central Queensland: 909Central Queensland: 724

Central West: 3

Gold Coast: 1,247

Darling Downs: 333

Central West: 19

Gold Coast: 1,251

Darling Downs: 108

Health Support Queensland: 1,389

Mackay: 247

Metro South: 1,194

Metro North: 825

North West: 56

South West: 26

Sunshine Coast: 867

Townsville: 507

West Moreton: 510

Wide Bay: 237

Wide Bay: 106

West Moreton: 208

Townsville: 957

Sunshine Coast: 826

North West: 2

Metro South: 1,748

Metro North: 2,178

Mater Health Services: 113

Mackay: 240

Figure 6: Number of CR inpatient referrals by source and destination HHS/organisation


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5 Patient characteristics

5.1 Age and genderDevelopmentofcardiovasculardiseaseisrelatedtoage.Overall,70%ofpatientsweremaleand30%female,whiletheagedistributionofreferralswassimilarforgenders.

Thehighestproportionofreferralsforbothmalesandfemaleswasinthe65yearsto69yearsagegroupwhichaccountedfor16%ofallreferrals.

Male

15% 10% 5% 0%

< 40

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

≥85

Years

Female

0% 5% 10% 15%

%oftotalreferrals(n=11,723)

Figure 7: Referrals by patient gender and age group

Table 6: Median patient age by gender and HHS

Outpatient HHS/division Male years

Female years

ALL years

CairnsandHinterland 64 63 64CentralQueensland 68 68 68

CentralWest 66 62 64DarlingDowns 67 66 66GoldCoast 68 70 68HealthSupportQueensland 64 67 65Mackay 61 66 63MetroNorth 66 67 67MetroSouth 64 66 64NorthWest 60 57 60SouthWest 67 58 61SunshineCoast 67 70 68Townsville 65 65 65WestMoreton 66 64 66WideBay 69 67 68Statewide 66 67 66


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5.2 Aboriginal and Torres Strait Islander statusEthnicityisanimportantdeterminantinthedevelopmentofcardiovasculardisease.ItisrecognisedthattheAboriginalandTorresStraitIslanderpopulationhasahigherincidenceandprevalenceofcoronaryarterydisease.Inthispatientset,AboriginalandTorresStraitIslanderpatientsrepresented6.3%ofallstatewidereferralswithconsiderablevariationobservedacrossallHHS.

LargerproportionsofAboriginalandTorresStraitIslanderpatientswerereferredtoCRprogramsinnorthernandwesternHHSwithCairnsandHinterland,NorthWest,TownsvilleandSouthWestHHSallreportinggreaterthan10%ofpatientsidentifyingasAboriginalandTorresStraitIslander.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%


Central Queensland

Central West

Darling Downs

Gold Coast


Mackay

Metro North

Metro South

North West

South West

Sunshine Coast

Townsville

West Moreton

Wide Bay

Statewide

Excludesmissingdata(3.9%)

Figure 8: Proportion of identified Aboriginal and Torres Strait Islander patients by outpatient HHS


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TheproportionofAboriginalandTorresStraitIslanderpatientsreferredtoCRhadamedianageconsiderablylowerthanotherpatients(56yearsvs66yearsrespectively).ThisfindingisconsistentwithotherQCORAudits,whichsuggeststhepresenceofacardiovasculardiseasehealthgapforAboriginalandTorresStraitIslanderpatients.

Male

15% 10% 5% 0%

< 40

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

≥85

Years

Female

0% 5% 10% 15%

Legend: Indigenous male Indigenous female Non Indigenous

Excludesmissingdata(3.9%)

Figure 9: Proportion of all CR referrals by age group and Indigenous status

Table 7: Patient age by gender and Indigenous status

Male years

Female years

All years

AboriginalandTorresStraitIslander 55 57 56NonAboriginalandTorresStraitIslander 66 68 66ALL 66 67 66


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6 Program participation

6.1 Pre assessment stageTheassessmentofapatientbyCRcomprisesacomprehensivecardiovasculardiseaseriskfactorreview.Thisextendsbeyondapatient’spresentingmedicalandsocialhistorytoencompassoverallhealth,physicalwell-being,psychologicalfactors,availabilityofsocialsupportandpatient-reportedqualityoflife.

AnassessmentbyoutpatientCRisgenerallyconductedintwostageswhichoccurbeforeandafterapatientattendsthespecialistCRprogram.Thesestagesarereferredtoasthepreassessmentandpostassessment.ThepreassessmentsignifiesthesuccessfuluptakeandrecruitmentofapatientontotheCRprogram.Assessmentsmaybeundertakenoverthephoneorface-to-face.

Theproportionoftotalreferralswhichproceededtoapreassessmentwithinanytimeframewas65%.Itshouldbenotedthatthisisaverylimitedmetricwhichshouldbeinterpretedwithcaution.ThisisduetovaryingprocessesacrossthestateforpatientsrefusingornotinterestedinattendingCR,aswellaspatientsresidingoverseasandinterstate.Theseissuesarediscussedlaterinthereport.

Table 8: Total pre assessments completed by HHS

Outpatient HHS/division Pre assessment completed n (%)

Declined/not assessed n (%)

Missing data n (%)

CairnsandHinterland 451(62.2) 231(31.9) 43(5.9)CentralQueensland 862(63.0) 506(37.0) –CentralWest 25(64.1) 14(35.9) –DarlingDowns 310(65.4) 129(27.2) 35(7.4)GoldCoast 944(59.1) 654(40.9)* –HealthSupportQueensland 1,042(66.5) 525(33.5) –Mackay 139(46.6) 105(35.2) 54(18.1)MetroNorth 701(59.7) 474(40.3) –MetroSouth 1,337(81.2) 310(18.8) –NorthWest 70(88.6) 9(11.4) –SouthWest 37(82.2) 6(13.3) 2(4.4)SunshineCoast 642(66.3) 327(33.7) –Townsville 282(45.2) 209(33.5) 133(21.3)WestMoreton 597(72.1) 228(27.5) 3(0.4)WideBay 222(77.4) 65(22.6) –Statewide 7,661 (65.4) 3,792 (32.3) 270 (2.3)* TotalforGoldCoastHHSincludes23%ofreferralsforpatientsresidinginterstate,whoaretypicallyreferredforCRoutsideof

QueenslandHealth


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Pre assessment completed Declined/not assessed Missing data

0% 25% 50% 75% 100% 0% 25% 50% 75% 100% 0% 25% 50% 75% 100%


Central Queensland

Central West

Darling Downs

Gold Coast*

Health SupportQueensland

Mackay

Metro North

Metro South

North West

South West

Sunshine Coast

Townsville

West Moreton

Wide Bay

Statewide

* TotalforGoldCoastHHSincludes23%ofreferralsforpatientsresidinginterstate,whoaretypicallyreferredforCRoutsideofQueenslandHealth

Figure 10: Proportion of CR referrals proceeding to pre assessment by HHS


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6.2 Post assessment stageThepostassessmentisrepresentativeofcompletionandgraduationfromthespecialistCRoutpatientprogram.Thisprovidesanopportunityforthepatientandcliniciantoreflectuponthetargetsdefinedatthepreassessment.Of7,661completedpreassessments,therewereanoverall40%ofpatientswhoproceededtoacompletedpostassessment.

CompletionratesandmediantimedelaysfrompostassessmenttopreassessmentvariedconsiderablybyHHS.Themediantimefrompreassessmenttopostassessmentwas82days,rangingfrom55daysto167daysacrossoutpatientHHS.Therewasalsoaconsiderablevariationintheproportionofcaseswhereapostassessmenthadbeencompleted,indicatingthatlocalpracticestowardspostassessmentcompletionanddataentryvaryconsiderablyatalocallevel.Furthermore,arangeofissuesmaycontributetocompletionofthepostassessment,whichmayincludetiming,patientavailabilityorotherfactorsoutsidethecontroloftheprogram.

Thishasbeenidentifiedasanareaforfuturefocusandexpandingofreporting,asitwouldallowmorecomprehensiveanalysisaroundoutcomesandpatientbenefitsforCR.Thedatareportedinthissectionusesaminimum90daywindowforpostassessmentcompletion,whichmayskewresultsforsitesusinglongerprogramtimeframes.

Table 9: Total post assessments completed by HHS

Outpatient HHS/division Post assessment completed

n (%)

Median time to post assessment days

CairnsandHinterland 166(36.8) 76CentralQueensland 391(45.4) 74CentralWest 14(56.0) N/ADarlingDowns 173(55.8) 65GoldCoast 354(37.5) 76HealthSupportQueensland 488(46.8) 167Mackay 70(50.4) 68MetroNorth 277(39.5) 106MetroSouth 701(52.4) 71NorthWest 13(18.6) N/ASouthWest 15(40.5) N/ASunshineCoast 78(12.1) 97Townsville 10(3.5) N/AWestMoreton 232(38.9) 73WideBay 101(45.5) 55Statewide 3,083 (40.2) 82N/A:Notdisplayeddueto<20postassessmentsforanalysis


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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Central Queensland

Central West

Darling Downs

Gold Coast


Mackay

Metro North

Metro South

North West

South West

Sunshine Coast

Townsville

West Moreton

Wide Bay

Statewide

N/A

N/A

N/A

N/A

N/A:Notdisplayeddueto<20postassessmentsforanalysis

Figure 11: Proportion of CR pre assessments proceeding to post assessment


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6.3 Program outcomesThefollowingsectionsusepairedobservationsfromthepreassessmentandpostassessmentstagestoidentifychangesinhealthstatusforpatientsparticipatinginCR.Measuresincludedinthisanalysisincludepatientreportedoutcomemeasures(PROMs)andotherfunctionalorpathologicalinvestigations.

Alimitingfactorforthisanalysisisavailabilityofdataforthepostassessmentstage.Specifically,theavailabilityofupdatedpathologyandotherinvestigations,andspecificmodelofcareemployedbytheCRprogrammayresultinlimiteddatafromwhichconclusionscanbedrawn.

Table 10: Outline of CR program outcome measures

Program outcome Measure Category1 Lipidprofile Pathology2 Sixminutewalktest Functional3 PatientHealthQuestionnaire PROMs4 AssessmentofQualityofLife PROMs

6.3.1 Lipid profile

DataforlipidvaluessuchastotalcholesterolwasavailableforasmallerproportionofpatientscompletingCR.Abarriertoreportingthisoutcomeisthatupdatedpathologyresultsarenotalwaysavailableforthepostassessmentstage.

Inthisanalysis,HDL-Cvaluesremainedconsistentwhiletotalcholesterol,LDL-C,andtriglyceridesshowedafavorabletrend.ThisisconsistentwithimprovementinlipidprofilepostCR.

Table 11: Summary of lipid values

Total analysed n

Pre assessment Mean ± SD

Post assessment Mean ± SD

Change in value Mean ± SD

Totalcholesterol(mmol/L) 398 4.7±1.4 3.8±1.0 -0.9±1.3Triglycerides(mmol/L) 364 1.7±1.0 1.4±0.8 -0.3±0.9HDL-C(mmol/L) 338 1.1±0.3 1.1±0.4 0.0±0.3LDL-C(mmol/L) 329 2.7±1.2 1.8±0.9 -0.9±1.2


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6.3.2 Six minute walk test

Afunctionalmeasureisindicatedpriortoimplementinganexerciseprograminordertodetermineexerciseprescriptionandmeasureimprovement.Thesixminutewalktest(6MWT)isastandardisedinvestigationofsubmaximalexercisecapacitythatisoftenusedinpatientswithcardiopulmonarydisease.ChangesinwalkdistanceareusefulinassessingfunctionalcapacityandtheefficacyoftherapeuticinterventionssuchaspharmacotherapyandCR.23

Forthe3,083postassessmentscompleted,therewere1,884caseswherethepatienthadcompleteda6MWTatboththepreassessmentandpostassessmentstages.The6MWTisnotalwaysfeasiblefordatacollectionduetothedifferentmodelsofcarethatexist,withsomeprogramsnotofferinganexercisecomponent.Inthemajorityoftheseinstances(75%)patientsdemonstratedanimprovementin6MWT,with57%showinganincreaseofgreaterthan50metres(Table13).

0

50

100

0 100 200 300 400 500 600 700 800 900Metres

0

50

100

Legend: Pre assessment (n) Post assessment (n) Median!

Interquartile range Normal distribution

Resultsroundedto10metres

Figure 12: Comparison of pre assessment and post assessment 6MWT results

Table 12: Summary of 6MWT results

Total analysed n



Change Mean ± SD

Distancetravelled(metres) 1,884 410±98 475±109 65±64

Table 13: Change in 6MWT results

n (%)Improved≥50metres 1,076(57.1)

Improved25–49metres 347(18.4)Nochange(±25metres) 377(20.0)Worsened≥25metres 84(4.5)ALL 1,884 (100.0)


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6.3.3 Patient Health Questionairre

TheCRassessmentoftenincludesabriefscreeningforanxietyanddepressivedisorders,bothofwhicharesignificantriskfactorsforpatientssufferingcoronaryarterydiseaseassociatedwithadversecardiovascularoutcomesindependentofotherriskfactors.

ThePatientHealthQuestionnaire-4(PHQ-4)isavalidatedtoolforscreeninganxietyanddepressivedisorders.24Thisinstrumentisafour-itemcompositemeasurederivedfromtheGeneralizedAnxietyDisorder-7scale(GAD–7)andthePatientHealthQuestionnaire-9(PHQ-9).EachofthefouritemsonthePHQ-4isscoredusingafourpointscalewithcategoriesofhighpsychologicaldistressbeingscored9–12pointsandmildpsychologicaldistressscoringbetween3–5points.Ascoreof0–2pointssuggestsminimaldepressionandanxiety.

Atotalof2,546paireddatawereavailableforanalysis.Almostone-thirdofpatients(32%)demonstratedanimprovedPHQ-4scoreatpostassessment.

0

500

1000

1500

2000

0 1 2 3 4 5 6 7 8 9 10 11 12PHQ-4 score

0

500

1000

1500

2000



Figure 13: Comparison of pre assessment and post assessment PHQ-4 results

Table 14: Summary of PHQ-4 results

Total analysed n



Change in score

Mean ± SDDepressionscore(PHQ-2) 2,546 0.7±1.2 0.5±1.1 -0.2±1.2Anxietyscore(GAD-2) 2,546 0.8±1.4 0.6±1.2 -0.3±1.3Overall score 2,546 1.5 ± 2.3 1.0 ± 2.0 -0.5 ± 2.1

Table 15: Change in PHQ-4 results

n (%)Anyimprovement 819(32.2)Nochange 1,336(52.5)Anyworseresult 391(15.4)ALL 2,546 (100.0)


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6.3.4 Assessment of Quality of Life

TheAssessmentofQualityofLife(AQoL-4D)isamulti-attributeutilityinstrumentdevelopedtoassesshealth-relatedqualityoflife.ItmeasuresPROMsacrossfourdomainsofhealth,scoredindividually,aswellasprovidinganoverallscore.AQoL-4Dutilityscoresrangefrom0.00–1.00,withscorescloserto1.00indicatinghighersatisfactionofpatientsreportingthestatusoftheirownhealth.

Forthe545recordsavailableatthepreandpostCRtimeframes,themeanoverallpreassessmentAQoL-4Dutilityscorewas0.71whichcomparessimilarlytoexpectedresultsforpatientswithacardiovasculardiagnosis.25Thisutilityscoreimprovedto0.78atthepostassessmentstage,where59%ofpatientsdemonstratedanimprovedoverallutilityscoreafterCRintervention(Table16andTable17).

0

50

100

150

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0AQoL-4D overall utility score

0

50

100

150



Resultsroundedto0.05utilityscore

Figure 14: Comparison of pre assessment and post assessment AQoL-4D results

Table 16: Summary of AQoL-4D results

Total analysed n



Change in score Mean ± SD

Independentliving 545 0.89±0.19 0.95±0.13 0.06±0.16Relationships 545 0.91±0.15 0.93±0.15 0.02±0.16Senses 545 0.94±0.10 0.94±0.09 0.01±0.09Mentalhealth 545 0.90±0.12 0.92±0.12 0.02±0.13Overall score 545 0.71 ± 0.24 0.78 ± 0.23 0.07 ± 0.22

Table 17: Change in AQoL-4D results

n (%)Anyimprovement 321(58.9)Nochange 74(13.6)Anyworseresult 150(27.5)ALL 545 (100.0)


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6.4 Failure to participateItiswellknownthatthereareseveralreasonspatientsmaynotparticipateinaCRprogram.Thiswasidentifiedasapointforfuturefocusthroughlastyear’sAudit.Subsequently,QCORhasbeenenhancedtoprovideincreasedgranularitywhichwillallowfuturereportstoincludemorespecificdetailaroundreasonsthismayoccur.Inthiscohortthemostcommonreasonfornotparticipatingwasthatthepatientwoulddeclineoroptnottoparticipate(30%).

Asidefrompatientsthatdeclinedtheservice,thereareanumberofspecificreasonsareferralmaynotproceedtopreassessment.Theseincludepatientswhoareuncontactable,failedtoattendtheirappointmentsoraremedicallyunsuitable.Interstatereferralsalsoaccountedforalargenumberofreferralswhichdidnotproceedthroughtoanassessment.ThisisparticularlyrelevantfortheGoldCoastHHSwhereahighproportion(23%)ofpatientsreferredtothisCRprogramareresidentsofnorthernNewSouthWalesandfollowedupoutsideofQueenslandHealth.

Itisimportanttorecognisethatinsomeinstances,theclinicianmaystillprovideopportunisticeducationandadvicetoapatientwhodeclinedtoparticipate,thoughthisisdifficulttoincorporateintooutcomemeasurereporting.Furthermore,thereisanunmeasuredsubsetofpatientswhorefusetheinitialreferraltoCRandarecurrentlyoutsidethescopeofthisregistry.

FurtherinformationrelatingtothepatientswhohaddeclinedtoparticipateinCRisincludedinsection8ofthisreport.

0% 5% 10% 15% 20% 25% 30%

Patient declined

Referred externally

Clinically inappropriate

Unable to contact

Failure to attend

Clinically unstable

Readmitted to hospital

Return to work

Patient deceased

Otherreasonsnotdisplayed(24%)

Figure 15: Reasons for no pre assessment being conducted


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7 Clinical presentation

7.1 Diagnosis PatientsattendingaCRpreassessmenthavebeengroupedintoadiagnosiscategoryforthefollowinganalysisbasedoninformationprovidedonthereferraltoCR.Themajorityofassessments(65%)followedapreviousdiagnosisofischaemicheartdisease(IHD).

Table 18: Pre assessments by diagnosis category

Diagnosis category n %Ischaemicheartdisease* 4,982 65.0Valvulardisease 637 8.3Other† 2,042 26.7ALL 7,661 100.0* STEMI,NSTEMIandangina

† Typicallyincludesarrhythmia,congestiveheartfailureandanyotherdiagnosis

7.2 Most recent procedureThemostcommonprocedureprecedingreferraltoCRwaspercutaneouscoronaryintervention(PCI),whichhadbeendocumentedfor39%ofallreferralsandapproximatelyhalf(52%)ofreferralsforpatientswithIHD.

Therewere14%ofcaseswherethemostrecentprocedurehadnotbeenidentified.Thiscouldbeattributabletomissingdataorpatientspresentingandsubsequentlybeingconservativelymanagedthushavingnoprocedureapplicable.ThisambiguityhasbeenidentifiedasapointforfutureimprovementstoQCOR.

Table 19: Most recent procedure by diagnosis category

Most recent procedure Ischaemic heart disease

n (%)

Valvular disease n (%)

Other n (%)

ALL n (%)

PCI 2,593(52.0) 5(0.8) 400(19.6) 2,998(39.1)Coronaryangiogram 921(18.5) 25(3.9) 429(21.0) 1,375(17.9)CABG 798(16.0) 47(7.4) 270(13.2) 1,115(14.6)Valveprocedure 11(0.2) 452(71.0) 76(3.7) 539(7.0)Deviceprocedure 16(0.3) 2(0.3) 156(7.6) 174(2.3)CABG+valveprocedure 66(1.3) 62(9.7) 25(1.2) 153(2.0)Other 61(1.2) 12(1.9) 173(8.5) 246(3.2)Notspecified 516(10.4) 32(5.0) 513(25.1) 1,061(13.8)


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7.3 Risk factors and comorbiditiesThefollowingriskfactorsandcomorbiditiesarediscussedwiththepatientthroughtheassessmentphaseandgenerallyself-reportedbythepatient.Withallself-reportinginstances,itisimportanttonotethatsometimesresponsesarenotaccuratelyconveyedwhilethepatientandclinicianareintheestablishmentphaseoftheirrelationship.Asaresult,someoftheriskfactormetricsmaybeunderstated.

7.3.1 Smoking

Atthetimeofthepre-assessment,9%ofpatientswereidentifiedascurrentsmokers(definedassmokingwithin30days),while51%wereclassedasformersmokersand40%reportedneverhavingsmoked.

Current smoker Former smoker Never smoked

0% 25% 50% 75% 100% 0% 25% 50% 75% 100% 0% 25% 50% 75% 100%

Ischaemic heart disease

Valvular disease

Other

ALL

Figure 16: Smoking status by diagnosis category

7.3.2 Activity level

Therewereonly36%ofpatientswhometthephysicalactivityguidelinesfortheirageandweresufficientlyactive.Conversely,18%ofpatientswereclassedasinactive,whichhadbeendefinedasonlyundertakingactivitiesassociatedwithdailyliving.Theremaining46%ofpatientswereclassedasinsufficientlyactiveaccordingtocurrentguidelines.

Sufficiently active Insufficiently active Inactive

0% 25% 50% 75% 100% 0% 25% 50% 75% 100% 0% 25% 50% 75% 100%


Valvular disease

Other

ALL

ExcludesCOACHassessments(n=1,042)

Figure 17: Activity level by diagnosis category


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7.3.3 Body mass index

Lessthanone-quarter(20%)ofpatientswereidentifiedashavingabodymassindex(BMI)withinthenormalrange,whilethemajority(80%)ofpatientsattendingoutpatientCRwereclassifiedasoverweight,obeseormorbidlyobese.Lessthanonepercentofpatientswereclassifiedasunderweight(BMI<18.5kg/m2).

Normal weight* Overweight† Obese‡ Morbidly obese§

0% 20% 40% 0% 20% 40% 0% 20% 40% 0% 20% 40%


Valvular disease

Other

ALL

Underweightcategory(<1%)notdisplayed

* BMI18.5–24.9kg/m2

† BMI25–29.9kg/m2

‡ BMI30–39.9kg/m2

§ BMI≥40kg/m2

Figure 18: BMI category by diagnosis category

7.3.4 Diabetes

Overall,27%ofpatientshaddiabetesasacomorbiditywithconsiderablevariationobservedbetweendiagnosiscategories,rangingfrom16%forvalvulardiseaseto28%intheIHDandotherdiagnosiscategories.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Valvular disease

Other

ALL

Figure 19: Diabetes status by diagnosis category

7.3.5 High blood pressure

Morethanhalfofpatientsassessed(62%)wereidentifiedashavinghypertension,rangingfrom57%to68%acrossdiagnosiscategories.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Valvular disease

Other

ALL


Figure 20: High blood pressure by diagnosis category


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7.3.6 Abnormal cholesterol

Themajorityofpatients(89%)hadahistoryofabnormalcholesterollevelsorhadbeenprescribedlipidloweringtherapybythetimeofassessment.Thisrangedfrom64%to95%acrossdiagnosiscategories.

Abnormalcholesterollevelsforpatientswithknowncardiovasculardiseaseincludemeasuresof:

•Totalcholesterol>4.0mmol/L

•HDL<1.0mmol/L

•LDL>2.0mmol/L

•Triglycerides>2.0mmol/L.26

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Valvular disease

Other

ALL

Figure 21: Abnormal cholesterol by diagnosis category

7.3.7 Family history of cardiovascular disease

Lessthanhalf(44%)ofpatientshadafamilyhistoryofcardiovasculardisease.Thishadbeendefinedashavingafirstdegreerelativediagnosedwithcardiovasculardiseasebytheageof60years.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Valvular disease

Other

ALL

Figure 22: Family history of cardiovascular disease by diagnosis category

7.3.8 History of depression

Overone-quarterofpatients(27%)hadahistoryofdepressionpriortothereferraltoCR.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Valvular disease

Other

ALL


Figure 23: History of depression by diagnosis category


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7.3.9 Heart failure

Overalltherewere12%ofpatientsassessedbyoutpatientCRwhoweredocumentedashavingheartfailure.Thiswashigherintheotherdiagnosiscategory,whichincludestheproportionofpatientshavingheartfailureasaprincipaldiagnosis.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Valvular disease

Other

ALL

Figure 24: Heart failure by diagnosis category

Heart failure and left ventricular (LV) dysfunction

Ofthepatientsdocumentedtohaveheartfailure(Figure24),79%wereclassedashavingHFwithareducedleftventricularejectionfraction(LVEF<50%).Ofthese,27%hadmildLVdysfunction,33%withmoderateLVdysfunctionand18%withsevereLVdysfunction.

Theremainder(21%)weredocumentedashavingheartfailureassociatedwithapreservedejectionfraction(LVEF≥50%).

Mild* Moderate† Severe‡

0% 25% 50% 75% 100% 0% 25% 50% 75% 100% 0% 25% 50% 75% 100%


Valvular disease

Other

ALL

* LVEF40–49%

† LVEF30–39%

‡ LVEF<30%

Figure 25: Proportion of HF patients with reduced ejection fraction by LV dysfunction and diagnosis category

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Valvular disease

Other

ALL

Figure 26: Proportion of HF patients with preserved ejection fraction by diagnosis category


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7.4 Current medicationsOverthree-quartersofpatientswerebeingtreatedwithaspirin(83%)andlipidloweringmedications(84%).Asexpected,therewasvariationinmedicationacrossdiagnosiscategories.PatientswithIHDtendedtouseantiplateletandsublingualnitratemedicationsmorethanpatientswithvalvulardiseasewhichisconsistentwiththedifferentdiseaseprocesses.

Table 20: Current medications by diagnosis category

Medications IHD %

Valvular disease %

Other %

ALL %

Aspirin 90.9 64.3 69.1 82.9ACEI/ARB 65.7 39.8 57.5 61.4Antiplatelet 66.0 9.5 34.1 52.9Anticoagulant 16.8 46.8 25.1 21.5Betablocker 65.8 45.6 60.2 62.6Diabeticmedications 22.4 13.8 23.9 22.1Dualantiplatelet 62.2 7.0 29.1 48.8Lipidlowering 90.8 57.3 74.1 83.6Sublingualnitrate 58.1 6.0 27.3 45.6Other 59.3 77.1 67.3 62.9


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8 Clinical indicatorsTheCRclinicalindicatorprogramremainsfocusedtowardsthetimelyreferralanduptaketoCRforadmittedpatientsbeingdischargedfrompublichospitals.Thisrequirescollaborationbetweentheacuteandoutpatientservices,eachhavingtheirowntargets(clinicalindicator1and2respectively).

Overallsystemperformanceismeasuredthroughclinicalindicator3,whichrequirestheacuteandoutpatientservicestobothmeettheirrespectivetargets.Forthepurposeofthisindicator,anyreferralscrossingbetweenHHSarecountedunderboththereferringandreceivingHHS.

AfuturefocusforthecommitteewillbetoexpandthescopeoftheCRclinicalindicators.Severalareashavebeenhighlightedincludingreferralsfromanon-acutesettingandimprovementatthepostassessmentstage.DiscussionhashighlightedaneedforconsistentCRpracticeandrobustdataentrypriortoimplementationofanynewclinicalqualityindicators.

Table 21: Cardiac rehabilitation clinical indicators

# Clinical indicator Description1 Timelyreferral DocumentedreferraltoCRwithinthreedaysofdischarge2 Timelyassessment InitialCRpreassessmentcompletedwithin28daysofdischarge3 Timelyjourney Compositeoftimelyreferralandassessment

Timely assessmentTimely referral

Day 3Post

Discharge

Day 1Hospital

Discharge

Day 28Post

Discharge

Timely journey

Figure 27: Timely referral, assessment and overall journey


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8.1.1 Timely referral

ThisindicatorexaminestheproportionofinpatientreferralstoCRoriginatingfromapublichospitalwhichhadbeenprovidedtotheCRprograminatimelymanner.Thisrequiresthereferraltobesubmittedtotheoutpatientprogramwithinthreedaysofthepatientbeingdischargedfromhospital.

Overallperformanceishigh,with95%ofreferralscontributedtoQCORbeingsubmittedwithinthreedaysofdischarge.

Table 22: Timely referrals by referring HHS

Referring HHS/organisation Total inpatient referrals n

Target met n (%)

CairnsandHinterland 500 473(94.6)CentralQueensland 724 703(97.1)CentralWest 3 N/ADarlingDowns 108 105(97.2)GoldCoast 1,251 1,128(90.2)Mackay 240 225(93.8)MaterHealthServices 113 101(89.4)MetroNorth 2,178 2,058(94.5)MetroSouth 1,748 1,703(97.4)NorthWest 2 N/ASunshineCoast 826 814(98.5)Townsville 957 906(94.7)WestMoreton 208 198(95.2)WideBay 106 102(96.2)Statewide 8,964 8,519 (95.0)N/A=Notdisplayeddueto<20referralseligibleforanalysis


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Rorganisation

eferring HHS/ Referring site Tn

otal analysed

0% 20% 40% 60% 80% 100%

Cairns and Hinterland Cairns Hospital 500

Central Queensland Rockhampton Hospital 714

Darling Downs Toowoomba Hospital 104

Gold Coast Gold Coast University Hospital 1,245

Mackay Mackay Base Hospital 240

Mater Health Services Mater Hospital Brisbane 113

Metro North Caboolture Hospital 115

Redcliffe Hospital 58

Royal Brisbane & Women's Hospital 449

The Prince Charles Hospital 1,556

Metro South Logan Hospital 107

Princess Alexandra Hospital 1,513

Queen Elizabeth II Jubilee Hospital 48

Redland Hospital 80

Sunshine Coast Sunshine Coast University Hospital 822

Townsville The Townsville Hospital 957

West Moreton Ipswich Hospital 208

Wide Bay Bundaberg Base Hospital 103

Statewide

Siteswith<20referralseligibleforanalysisnotdisplayed

Figure 28: Timely referrals by referring hospital


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8.1.2 Timely assessment

ThisindicatorexaminestheproportionofreferralstoCRwhichproceedtoanassessmentwithin28daysofdischarge.

InordertoretainfocusontheperformanceoftheoutpatientCRprogram,referralswhicharenotprovidedinatimelymanner(lessthanthreedaysfromdischarge)havebeenexcludedfromtheanalysis.Furthertothis,otherineligibilitycriteriaareoutlinedinTable20.Theexclusionsareappliedwhereinformationisavailableandhasbeendocumentedintheapplication.

Overall,morethanhalfofallpatients(62%)arebeingassessedinatimelymanner,howevertherewassomevariationacrosshealthservices.

Table 23: Summary of referrals ineligible for timely assessment clinical indicator

Summary nReferredoutsideofQueenslandHealth 525Referralsubmitted>3daysafterdischarge 388PatientalreadyattendingCRprogram 101Readmittedtohospital 88Patientdeceased 37Total ineligible 1,139

Table 24: Timely assessment indicator by outpatient HHS

Outpatient HHS/division Total inpatient referrals n

Total eligible for analysis n

Target met n (%)

CairnsandHinterland 598 521 309(59.3)CentralQueensland 909 790 358(45.3)CentralWest 19 13 N/ADarlingDowns 333 309 161(52.1)GoldCoast 1,247 803 588(73.2)HealthSupportQueensland 1,389 1,239 652(52.6)Mackay 247 218 77(35.3)MetroNorth 825 770 455(59.1)MetroSouth 1,194 1,133 912(80.5)NorthWest 56 50 43(86.0)SouthWest 26 24 14(58.3)SunshineCoast 867 805 567(70.4)Townsville 507 464 214(46.1)WestMoreton 510 474 315(66.5)WideBay 237 212 150(70.8)Statewide 8,964 7,825 4,818 (61.6)

N/A=Notdisplayeddueto<20referralseligibleforanalysis


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Outpatient HHS/division Program Tn

otal analysed

0% 20% 40% 60% 80% 100%

Cairns and Hinterland Atherton 51

Cairns 367

Innisfail 42

Mareeba 22

Mossman 22

Central Queensland Biloela 26

Capricorn Coast 97

Gladstone 78

Rockhampton 589

Darling Downs Dalby-Tara 22

Kingaroy 56

Stanthorpe 24

Toowoomba 153

Warwick 31

Gold Coast Gold Coast 803

Health Support Queensland COACH 1,239

Mackay Mackay 156

Proserpine 46

Metro North Caboolture 224

Chermside 240

North Lakes 191

Redcliffe 115

Metro South Bayside 261

Eight Mile Plains 130

Inala 75

Logan-Beaudesert 430

Princess Alexandra Hospital 237

North West Mt Isa 50

Sunshine Coast Caloundra 219

Gympie 155

Maroochydore 130

Nambour 164

Noosa 137

Townsville Ayr 53

Charters Towers 30

Ingham 30

Townsville 346

West Moreton Ipswich 474

Wide Bay Hervey Bay 128

Maryborough 84

Statewide

Siteswith<20preassessmentseligibleforanalysisnotdisplayed

Figure 29: Timely assessment by outpatient program


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8.1.3 Timely journey

Thispatient-centricmeasureofoverallsystemperformancerequiresstrongcoordinationandlinksbetweenthereferringacuteandoutpatientCRsites.Itmeasurestheproportionofeligibleinpatientreferralssubmittedbytheacutesitewithinthreedaysofdischarge,aswellastheabilityofthereceivingCRprogramtomeetthetargetofcompletingapreassessmentwithin28daysofdischarge.

ReferralsareexcludedfromtheanalysisforthereasonsoutlinedinTable25.Theexclusionsareappliedwhereinformationisavailableandhasbeendocumentedintheapplication.

Itisimportanttonotethatforthepurposeofthisindicator,anyreferralwhichcrossesbetweenHHSiscountedagainstbothparticipatingservices.

Table 25: Summary of referrals ineligible for timely journey clinical indicator

Summary nReferredoutsideofQueenslandHealth 525PatientalreadyattendingCRprogram 101Readmittedtohospital 88Patientdeceased 37Total ineligible 751

Table 26: Timely journey indicator by participating HHS/organisation

Participating HHS/organisation Total inpatient referrals* n

Total eligible for analysis n

Target met n (%)

CairnsandHinterland 624 572 324(56.6)CentralQueensland 979 885 372(42.0)CentralWest 19 16 N/ADarlingDowns 361 343 175(51.0)GoldCoast 1,290 920 607(66.0)HealthSupportQueensland 1,389 1,326 652(49.2)Mackay 337 319 126(39.5)MaterHealthServices 113 113 69(61.1)MetroNorth 2,214 2,115 1,259(59.5)MetroSouth 1,939 1,894 1,347(71.1)NorthWest 56 54 43(79.6)SouthWest 26 25 14(56.0)SunshineCoast 998 936 646(69.0)Townsville 970 934 415(44.4)WestMoreton 514 501 316(63.1)WideBay 340 320 206(64.4)Statewide 8,964 8,213 4,818 (58.7)N/A=Notdisplayeddueto<20referralseligibleforanalysis

* Includesbothincomingandoutgoingreferrals


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P/organisation

articipating HHS Tn

otal analysed

0% 20% 40% 60% 80% 100%

Cairns and Hinterland 572

Central Queensland 888

Central West 16

Darling Downs 343

Gold Coast 924

Health Contact Centre 1,326

Mackay 320

Mater Health Services 113

Metro North 2,120

Metro South 1,895

North West 54

South West 25

Sunshine Coast 938

Townsville 935

West Moreton 501

Wide Bay 323

Statewide 8,227

N/A

N/A:Notdisplayeddueto<20referralseligibleforanalysis

Figure 30: Timely journey indicator by participating HHS/organisation


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9 Declined referralsAninitiativeofthe2017CRauditwastofurtherdefinethesubsetofpatientswhodidnotuptakeCRforwhateverreason,withtheaimtoincreasethelevelofdetailavailabletodescribethebarrierstoparticipation.

ThecohortofpatientswhodeclinedtoparticipateinCRhavebeenexaminedwithanaimtoidentifycommonthemesandopportunitiesforclinicianstoimprovepatientparticipationrates.Alimitingfactorforthisanalysisistheamountofdataavailabletodescribethiscohort,whichislimitedtotheinformationincludedontheinitialreferralonly.

9.1 Age and gender PatientsmostlikelytodeclineCRparticipationaremalesaged70yearsto74years(12%).ThelargestgroupoffemalestodeclineCRwereagedinthe80yearsto84yearscategory(5%).

Conversely,patientsaged65yearsto69years(17%)werethemostlikelytocompleteaCRprogram.

Male

15% 10% 5% 0%

< 40

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

≥85

Years

Female

0% 5% 10% 15%

Legend: Patient declined (male) Patient declined (female) Completed pre assessment

Figure 31: Patient CR program participation status by age group and gender

Table 27: Patient age (years) by program participation status

Male Median (IQR)

Female Median (IQR)

ALL Median (IQR)

Patientdeclined 68(60–75) 71(61–81) 69(60–77)Fullyassessed 65(57–72) 67(58–74) 66(57–73)


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9.2 Diagnosis category Ofthepatientswhodeclined,42%hadadiagnosisofischaemicheartdiseaseand5%valvulardisease.Bycomparison,patientswhohadcompletedaninitialassessmentweremorecommonlyassociatedwithischaemicheartdiseaseandvalvularheartdisease(65%and8%respectively).Mostpatients(53%)whodeclinedCRhadanotherdiagnosis.

Completed pre assessment Patient declined

0% 25% 50% 75% 100% 0% 25% 50% 75% 100%


Valvular disease

Other

Figure 32: Proportion of cases by diagnosis category and program participation status

Table 28: Diagnosis category by program participation status

Diagnosis category Completed pre assessment n (%)

Patient declined n (%)

Ischaemicheartdisease 4,982(65.0) 459(42.0)Valvulardisease 637(8.3) 50(4.6)Other 2,042(26.7) 583(53.4)ALL 7,661 (100.0) 1,092 (100.0)

9.3 Most recent procedure Overall,20%ofpatientsthathaddeclinedtoparticipateinCRwererecordedashavingundergonePCI,whileapproximately5%hadundergoneCABG.Almosthalfofpatients(46%)whodeclinedCRhadnorecentprocedurespecified.

Forthecohortthatproceededtoassessment,theirmostrecentprocedurewasmorecloselyrelatedtotheirparticipationstatus.ThisdatasuggeststhatpatientswhowentontouptakeontoaCRprogrammaybemorelikelytohaveundergoneaninvasivecardiacprocedurepriortoreferral.However,careshouldbetakenwheninterpretingthesefindingsasthisdataelementisnotalwayscompletedatthetimeofreferral.Therefore,itmaynotfullyrepresenttheprecedingpatientmedicalhistory.

Completed pre assessment Patient declined

0% 10% 20% 30% 40% 50% 0% 10% 20% 30% 40% 50%

PCI

Coronary angiogram

CABG

Valve procedure

Device procedure

CABG + valve procedure

Other

Not specified

Figure 33: Proportion of cases by most recent procedure and program participation status


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Table 29: Most recent procedure by program participation status

Most recent procedure Completed pre assessment n (%)


PCI 2,998(39.1) 213(19.5)Coronaryangiogram 1,375(17.9) 215(19.7)CABG 1,115(14.6) 48(4.4)Valveprocedure 539(7.0) 45(4.1)Deviceprocedure 174(2.3) 18(1.6)CABG+valveprocedure 153(2.0) 10(0.9)Other 246(3.2) 42(3.8)Notspecified 1,061(13.8) 501(45.9)ALL 7,661 (100.0) 1,092 (100.0)

9.4 Place of residenceAhigherproportion(49%)ofpatientsdecliningtoparticipateinCRresidedinmajorcitiesofAustralia.Irrespectiveofgeographiclocation,thereweresimilarproportionateratesforthosewhohadtakenupCRandthosewhohaddeclined.

Table 30: Remoteness classification by program participation status

Remoteness classification* Completed pre assessment n (%)


MajorCitiesofAustralia 4,030(52.6) 536(49.1)InnerRegionalAustralia 2,283(29.8) 332(30.4)OuterRegionalAustralia 1,073(14.0) 182(16.7)RemoteAustralia 92(1.2) 14(1.3)VeryRemoteAustralia 176(2.3) 24(2.2)ALL 7,661 (100.0) 1,092 (100.0)* ClassifiedbyAccessibilityandRemotenessIndexofAustralia


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Legend: Patient participating in CR Patient decline of CR

Figure 34: Patient residential postcode by program participation status


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10 ConclusionsThisreportisthefirsttoaddafullyearofdataregardingpatientsreferredtoanyofthe60publicCRsitesinQueensland.Inparticular,forthe55siteswhichhadcontributeddatatoQCORfor2018.Thisaddstoagrowingbodyofinformationdescribingthebaselinedemographics,clinicalpresentationandriskfactorsaffectingpatientsreferredtoapublicCRservice.

Thedataoffersrichinsightintotheprocessofcarefor11,723newreferralsin2018.Acrosstheanalysis,thedataisreassuringandshowsthemajorityofpatientshadbeenreferredforandreceivedaninitialassessmentinatimelymanner(95%and62%meetingrespectivebenchmarks).Wherepostassessmentdatawereavailable,itisalsogratifyingtoseeoverhalfofpatientshadbeendocumentedwithanimprovedhealthstatusacrossthemajorityofmetricsanalysed.

ThroughtheincreasedscopeoftheCRAudit,clearvariationsinpracticehavebeenidentifiedacrossthestate.Thisishighlightedbythedeliberateinclusionofseveralsites(Goondiwindi,Stanthorpe,Bowen,AyrandHughenden)whichhaveyettocontributedatathroughQCOR.Itishopedthisinclusionmaydrawattentiontostaffingandresourceavailabilityforthosesites.Acrossthestatetherelativelackofdescriptivedataforstaffingandpractitionerdisciplines,andinabilitytocorrelatereportedresultsagainstthemodelofcareemployedbyeachsitehinderstheanalysisandmakesitdifficulttodrawfirmconclusionsatthistime.

Similarly,thereporthighlightsvaryingpracticestowardspatientsassumedeligibleforCRbutnotreceivingareferralforwhateverreason.Thismayoccuratthebehestofthepatientorthroughothercircumstancesoutsideofthepatient’scontrol.ItmustbeacknowledgedthereareclearlimitationsinreportingforpatientswhohadrefusedorotherwisehadnotbeenreferredforCR.Thisformsagapinthecurrentanalysisandlimitstheabilitytofullydescribesuchbarrierstoparticipation.ThisisdespitethespotlightonpatientswhorefusedorrejectedtoattendaCRprogramasfurtherinvestigationisclearlywarranted.

Theinitialexaminationofpostassessmentoutcomesyieldspromisingresultssuggestingclearbenefitsforpatientswhocompletedboththepreassessmentandpostassessmentstages.However,thesefindingsmustbeinterpretedwithcautionduetothereducedcasesincludedintheseanalysesandinconsistentpostassessmentcompletionrates.Hencethereispotentialforaselectionbiastobeinplay.Nevertheless,theinitialdataspeaksvolumesfortheuniquepotentialforCRdatatosatisfyquestionsregardingpatient-reportedoutcomesandexperiencesinpost-dischargecare.

Asthedatacollectioncontinuestomatureandevolve,itisexpectedthatthiswillallowmoresophisticatedanalysesinfutureaudits.ThiswouldincludelinkagesbetweentheCRreportdataandotherQCORdatacollections,whichwouldfollowtheoverallregistry’sdirectiontowardsamorepatient-centricanddisease-basedmodelofreporting.ThecontinuedsupportofCRcliniciansisrecognisedandvitaltoensuringtheongoingsuccessanddevelopmentofCRservices,andachievingqualitypatientoutcomesacrossQueensland.

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ReferencesCardiac Rehabilitation Audit

23. Gremeaux,V.,Troisgros,O.,Benaïm,S.,Hannequin,A.,Laurent,Y.,Casillas,J.-M.,&Benaïm,C.(2011).DeterminingtheMinimalClinicallyImportantDifferencefortheSix-MinuteWalkTestandthe200-MeterFast-WalkTestDuringCardiacRehabilitationPrograminCoronaryArteryDiseasePatientsAfterAcuteCoronarySyndrome.Archives of Physical Medicine and Rehabilitation,92(4),611–619.

24. Kroenke,K.,Spitzer,R.L.,Williams,J.B.,&Lowe,B.(2009).AnUltra-BriefScreeningScaleforAnxietyandDepression:ThePHQ-4.Psychosomatics, 50(6),613–621.

25. Hawthorne,G.,Korn,S.,&Richardson,J.(2013).PopulationnormsfortheAQoLderivedfromthe2007AustralianNationalSurveyofMentalHealthandWellbeing.Australian and New Zealand Journal of Public Health, 37(1),7–16.

26. VascularDiseasePreventionAlliance(2012).Guidelines for the management of absolute cardiovascular disease risk. Melbourne: National Stroke Foundation.Retrievedfrom:https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf

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Glossary6MWT SixMinuteWalkTestACC AmericanCollegeofCardiologyACEI AngiotensinConvertingEnzymeInhibitorACOR AustralasianCardiacOutcomesRegistryACS AcuteCoronarySyndromesANZSCTSAustralianandNewZealandSocietyofCardiac

andThoracicSurgeonsAQoL AssessmentofQualityofLifeARB AngiotensinIIReceptorBlockerARNI AngiotensinReceptor-NeprilysinInhibitorsASD AtrialSeptalDefectATSI AboriginalandTorresStraitAV AtrioventricularAVNRT AtrioventricularNodalRe-entryTachycardiaBCIS BritishCardiovascularInterventionSocietyBiV BiventricularBMI BodyMassIndexBMS BareMetalStentBNH BundabergHospitalBSSLTX BilateralSequentialSingleLungTransplantBVS BioresorbableVascularScaffoldCABG CoronaryArteryBypassGraftCAD CoronaryArteryDiseaseCBH CabooltureHospitalCCL CardiacCatheterLaboratoryCH CairnsHospitalCHF CongestiveHeartFailureCI ClinicalIndicatorCR CardiacRehabilitationCRT CardiacResynchronisationTherapyCS CardiacSurgeryCV CardiovascularCVA CerebrovascularAccidentDAOH DaysAliveandOutofHospitalDES DrugElutingStentDOSA DayOfSurgeryAdmissionDSWI DeepSternalWoundInfectionECG 12leadElectrocardiographECMO ExtracorporealMembraneOxygenationED EmergencyDepartmenteGFR EstimatedGlomerularFiltrationRateEP ElectrophysiologyFdECG FirstDiagnosticElectrocardiographFTR FailureToRescueGAD GeneralizedAnxietyDisorderGCCH GoldCoastCommunityHealthGCUH GoldCoastUniversityHospitalGLH GladstoneHospitalGP GeneralPractitionerGYH GympieHospitalHBH HerveyBayHospital(includesMaryborough)HF HeartFailureHFpEF HeartFailurewithPreservedEjectionFractionHFrEF HeartFailurewithReducedEjectionFractionHFSS HeartFailureSupportServiceHHS HospitalandHealthServiceHOCM HypertrophicObstructiveCardiomyopathyHSQ HealthSupportQueenslandIC InterventionalCardiology

ICD ImplantableCardioverterDefibrillatorIHT Inter-hospitalTransferIPCH IpswichCommunityHealthLAA LeftAtrialAppendageLAD LeftAnteriorDescendingArteryLCX CircumflexArteryLGH LoganHospitalLOS LengthOfStayLV LeftVentricleLVEF LeftVentricularEjectionFractionLVOT LeftVentricularOutflowTractMBH MackayBaseHospitalMI MyocardialInfarctionMIH MtIsaHospitalMRA MineralocorticoidReceptorAntagonistsMTHB MaterAdultHospital,BrisbaneNCDR TheNationalCardiovascularDataRegistryNOAC Non-VitaminKAntagonistOralAnticoagulantsNP NursePractitionerNRBC Non-RedBloodCellsNSTEMI NonST-ElevationMyocardialInfarctionOR OddsRatioPAH PrincessAlexandraHospitalPAPVD PartialAnomalousPulmonaryVenousDrainagePCI PercutaneousCoronaryInterventionPDA PatentDuctusArteriosusPFO PatentForamenOvalePHQ PatientHealthQuestionairreQAS QueenslandAmbulanceServiceQCOR QueenslandCardiacOutcomesRegistryQEII QueenElizabethIIHospitalQH QueenslandHealthQHAPDC QueenslandHospitalAdmittedPatientData

CollectionRBC RedBloodCellsRBWH RoyalBrisbaneandWomen’sHospitalRCA RightCoronaryArteryRDH RedcliffeHospitalRHD RheumaticHeartDiseaseRKH RockhamptonHospitalRLH RedlandHospitalSCCIU StatewideCardiacClinicalInformaticsUnitSCCN StatewideCardiacClinicalNetworkSCUH SunshineCoastUniversityHospitalSHD StructuralHeartDiseaseSTEMI ST-ElevationMyocardialInfarctionSTS SocietyofThoracicSurgeryTAVR TranscatheterAorticValveReplacementTMVR TranscatheterMitralValveReplacementTNM Tumour,LymphNode,MetastasesTPCH ThePrinceCharlesHospitalTPVR TranscatheterPulmonaryValveReplacementTTH TheTownsvilleHospitalTWH ToowoombaHospitalVAD VentricularAssistDeviceVATS Video-AssistedThoracicSurgeryVCOR VictorianCardiacOutcomesRegistryVF VentricularFibrillationVSD VentricularSeptalDefect

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Ongoing initiativesWhilstcontinuallyrefiningandimprovingdatacollectionandreportingpracticesforthebenefitofpublicfacilities,QCORisalsobeginningtheinvestigationofamethodtocollectandanalyseclinicaldataforprivatehealthcarefacilities.Followinginterestfromvariousprivateproviders,QCORislookingtoextenditsqualityandsafetyfocustoaccommodatetherequirementsofthesefacilities.ItisanticipatedthatQCORwillprovidearoleinthedeliveryofreportsandbenchmarkingactivitieswhilstalsoactingasaconduittothevariousnationalregistriesinexistenceanddevelopment.

CardiacoutreachcontinuestoexpandinQueenslandwithformalisedandnewlyfundedserviceshavingcommencedbetweenCairnsandHinterlandandTorresandCapeHospitalandHealthServiceintendingtoprovidecardiaccareinmanyofthesecommunitiesforthefirsttime.ServiceswillcommenceinJanuary2020betweenTownsvilleandNorthWest.Theforwardplanfortherolloutofthismodelacrossthestatehasbeendevelopedinpartnershipwithconsumersandclinicians.Anewsystem,theQCOROutreachapplicationhasbeendevelopedtotrackactivity,serviceprovisionandpatientoutcomes.Thisground-updevelopmentspecificallyforcardiacoutreachfinishedtestingandgoesliveforuseinlate2019.

TheQCORStructuralHeartDiseasemoduleiscurrentlyinadvancedstagesofdevelopmentwithwiderdeploymentexpectedin2020.ThisQCORmodulehasbeendevelopedtoprovidesuperiorprocedurereportingcapabilitiesforstructuralheartdiseaseinterventions,deviceclosure,andpercutaneousvalvereplacementandrepairprocedures.Itwillenableparticipationinnationalqualityandsafetyactivitiesfortranscatheteraorticvalvereplacementaswellasallowclinicianstoutilisetheapplicationforcollectingpreandpost-proceduraldatainunprecedenteddetail.Theapplicationhasbeenthroughrigoroustestingwithusertrainingandfurtherenhancementsplannedforthenearfuture.

TheECGFlashinitiativeoftheSCCNhascontinuedtobeimplementedatseveralsitesthroughout2018and2019.Deploymentofhardwaretospokesiteshasbeenviaastagedapproachwithuptakebeingvariedbasedonlocalsiteworkloadandworkforce.IntegrationofECGFlashwithworkflowwithinhubsitescontinuestoevolvewithsitesnowtakingtheinitiativetoembraceandfeedbacktositesregardingtheappropriateuseofthesystem.Analysisoftheutilityofthesystemisbeginningtotakeplacewithafocusonclinicalefficacyandbenefit.ItisanticipatedthatQCORwillbeabletosupportthisnewinitiativethroughprocedurallinkageandoutcomemonitoringforthesubsetofpatientswhoseclinicalpathutilisedECGFlashandwentontosubsequentinvestigationormanagement.

OpportunitiesforparticipationintheformativestagesofnationalregistriesandinitiativeshavebeenembracedbyQueenslandclinicians.TheseimportantinitiativeswhichareinvariousstageofdevelopmentwillbecriticaltothefutureofclinicalregistriesinAustralia.Itisanticipatedthatwithfurtherinvolvementfromlocalstakeholdersthattheseentitieswillevolveintorelevantandusefultoolsforpatient-centredreportingandoutcomes.

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Clinical Excellence Queensland · 2019. 12. 8. · The high level of clinical engagement extends beyond clinical practice to working collaboratively with Queensland Health administrators