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## Complete Summary

#### TITLE

Cardiac rehabilitation: percentage of patients in the healthcare
system\'s cardiac rehabilitation program(s) who meet the specified
performance measure criteria for lipid control.

#### SOURCE(S)

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, ACC/AHA Task
Force Members. AACVPR/ACC/AHA 2007 performance measures on cardiac
rehabilitation for referral to and delivery of cardiac
rehabilitation/secondary prevention services. J Cardiopulm Rehabil
Prev2007 Sep-Oct;27(5):260-90. \[74 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17885506)

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, American
Association of Cardiovascular and Pulmonary Rehabilitation/American.
AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for
referral to and delivery of cardiac rehabilitation/secondary prevention
services. Circulation2007 Oct 2;116(14):1611-42. \[74 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17885210)

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, Bonow RO,
Estes NA 3rd, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ,
Rumsfeld JS, Whitman GR, AACVPR, ACC, AHA, American College of Chest
Physicians, American College of Sports Medicine, American Physical
Therapy Association, Canadian Association of Cardiac Rehabilitation,
European Association for Cardiovascular Prevention and Rehabilitation,
Inter-American Heart Foundation, National Association of Clinical Nurse
Specialists, Preventive Cardiovascular Nurses Association, Society of
Thoracic Surgeons. AACVPR/ACC/AHA 2007 performance measures on cardiac
rehabilitation for referral to and delivery of cardiac
rehabilitation/secondary prevention services. J Am Coll Cardiol2007 Oct
2;50(14):1400-33. \[74 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17903645)

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients in the health
care system\'s cardiac rehabilitation program(s) who meet the specified
performance measure criteria for lipid control.

This performance measure is one of ten individual submeasures of the
measure subset, [Individualized Patient Assessment and Evaluation of
Modifiable Cardiovascular Risk Factors, Development of Individual
Interventions, and Communication with Other Healthcare
Providers](http://www.qualitymeasures.ahrq.gov/browse/DisplayOrganization.aspx?org_id=2005&doc=8768).

#### RATIONALE

Multiple clinical trials have shown the benefit of lipid-lowering agents
and lifestyle modification for patients with documented cardiovascular
disease (CVD). A more aggressive low-density lipoprotein target goal of
less than 70 mg/dL should be considered for persons with multiple
cardiovascular risk factors, particularly when they are under suboptimal
control (e.g., a patient with coronary artery disease who continues to
smoke).

#### PRIMARY CLINICAL COMPONENT

Cardiac rehabilitation program; lipid control

#### DENOMINATOR DESCRIPTION

Number of patients in the healthcare system\'s cardiac rehabilitation
(CR) program(s)

#### NUMERATOR DESCRIPTION

Number of patients in the healthcare system\'s cardiac rehabilitation
(CR) program(s) who meet the performance measure for lipid control (see
the related \"Numerator Inclusions/Exclusions\" field in the Complete
Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   A systematic review of the clinical literature

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [AHA/ACC guidelines for secondary prevention for patients with
    coronary and other atherosclerotic vascular disease: 2006
    update.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9373)

-   [Diet and lifestyle recommendations revision 2006. A scientific
    statement from the American Heart Association Nutrition
    Committee.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10453)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Stein JH, McBride PE. Closing the cholesterol treatment gap: cardiac
rehabilitation can make a difference. J Cardiopulm Rehabil2006
Nov-Dec;26(6):363-5.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17135856)

Taylor RS, Unal B, Critchley JA, Capewell S. Mortality reductions in
patients receiving exercise-based cardiac rehabilitation: how much can
be attributed to cardiovascular risk factor improvements. Eur J
Cardiovasc Prev Rehabil2006 Jun;13(3):369-74.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16926666)

### State of Use of the Measure

#### STATE OF USE

Pilot testing

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Home Care\
Hospitals\
Physician Group Practices/Clinics\
Rehabilitation Centers

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Nurses\
Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Unspecified

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better\
Staying Healthy

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients in the healthcare system\'s cardiac rehabilitation (CR)
program(s)

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients in the healthcare system\'s cardiac rehabilitation
(CR) program(s)

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window brackets index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients in the healthcare system\'s cardiac rehabilitation
(CR) program(s) who meet the performance measure\* for lipid control

\*For each eligible patient enrolled in the CR program, there is
documentation that the following criteria have been met:

1.  An assessment of blood lipid control and use of lipid-lowering
    medications, with target goals defined by the American Heart
    Association/American College of Cardiology (AHA/ACC) secondary
    prevention guidelines.

2.  For patients with a diagnosis of hyperlipidemia, an intervention
    plan has been recommended to the patient. This should include
    education about target lipid goals, importance of medication
    compliance, lifestyle modification for optimal dietary and regular
    physical activity habits, and weight control.

3.  Prior to completion of the CR program, lipid control and the lipid
    management plan, including lifestyle modification, are reassessed
    and communicated to the patient as well as to the primary care
    provider and/or cardiologist.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

The Cardiac Rehabilitation/Secondary Prevention Performance Measure
Writing Committee initially identified 39 factors from various practice
guidelines and other reports that were considered potential performance
measures for the Cardiac Rehabilitation/Secondary Prevention Performance
Measurement Sets (see Table 1 of the original measure documentation for
standard guidelines that were used to rate the classification of
recommendations and level of evidence for assessing these factors). The
group evaluated these factors according to guidelines established by the
American College of Cardiology/American Heart Association (ACC/AHA) Task
Force on Performance Measures. Those measures that were deemed to be
most evidence-based, interpretable, actionable, clinically meaningful,
valid, reliable, and feasible were included in the final performance
measurement sets. Once these measures were identified, the writing
committee then discussed and refined, over a series of months, the
definition, content, and other details of each of the selected measures.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, ACC/AHA Task
Force Members. AACVPR/ACC/AHA 2007 performance measures on cardiac
rehabilitation for referral to and delivery of cardiac
rehabilitation/secondary prevention services. J Cardiopulm Rehabil
Prev2007 Sep-Oct;27(5):260-90. \[74 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17885506)

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, Bonow RO,
Estes NA 3rd, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ,
Rumsfeld JS, Whitman GR, AACVPR, ACC, AHA, American College of Chest
Physicians, American College of Sports Medicine, American Physical
Therapy Association, Canadian Association of Cardiac Rehabilitation,
European Association for Cardiovascular Prevention and Rehabilitation,
Inter-American Heart Foundation, National Association of Clinical Nurse
Specialists, Preventive Cardiovascular Nurses Association, Society of
Thoracic Surgeons. AACVPR/ACC/AHA 2007 performance measures on cardiac
rehabilitation for referral to and delivery of cardiac
rehabilitation/secondary prevention services. J Am Coll Cardiol2007 Oct
2;50(14):1400-33. \[74 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17903645)

### Identifying Information

#### ORIGINAL TITLE

Performance measure B-3C: individualized assessment of optimal lipid
control.

#### MEASURE COLLECTION

[Cardiac Rehabilitation/Secondary Prevention Performance Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2005&doc=12066)

#### MEASURE SET NAME

[Cardiac Rehabilitation/Secondary Prevention Performance Measurement Set
B](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2005&doc=8992)

#### MEASURE SUBSET NAME

[Individualized Patient Assessment and Evaluation of Modifiable
Cardiovascular Risk Factors, Development of Individual Interventions,
and Communication with Other Healthcare
Providers](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2005&doc=8768)

#### DEVELOPER

American Association of Cardiovascular and Pulmonary
Rehabilitation/American College of Cardiology/American Heart Association

#### FUNDING SOURCE(S)

The Writing Committee had one face-to-face meeting at the outset of the
writing project. Funding travel to the meeting was covered by the
respective organizations (American Association of Cardiovascular and
Pulmonary Rehabilitation \[AACVPR\], American College of Cardiology
\[ACC\], and American Heart Association \[AHA\]). Conference calls were
paid for by AACVPR. Other than in these cases, there were no other
funding sources or reimbursements provided.

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

*American Association of Cardiovascular and Pulmonary Rehabilitation
(AACVPR) Representatives*: Randal J. Thomas, MD, MS (Physician,
Preventive Cardiologist, Mayo Clinic, Rochester, MN); Marjorie King, MD
(Physician, Cardiologist, Helen Hayes Hospital, West Haverstraw, NY);
Karen Lui, RN, C, MS (Nurse, GRQ Consulting Firm, Washington, D.C.);
Neil Oldridge, PhD (Exercise Science/Physiology, University of
Wisconsin-Milwaukee, Milwaukee, WI).

*American College of Cardiology (ACC) Representatives*: Ileana Piña, MD
(Physician, Cardiologist, Case Western Reserve University, Cleveland,
OH).

*American Heart Association (AHA) Representatives*: John Spertus, MD,
MPH (Physician, Cardiologist, Mid America Heart Institute/University of
Missouri-Kansas City, MO).

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

**Author Relationships with Industry \-- American Association of
Cardiovascular and Pulmonary Rehabilitation (AACVPR)/American College of
Cardiology (ACC)/American Heart Association (AHA) Cardiac
Rehabilitation/Secondary Prevention Performance Measures**

  -----------------------------------------------------------------------------------------
  **Writing   **Research    **Speakers\'              **Stock       **Consultant/Advisory
  Committee   Grant**       Bureau/Honoraria/Expert   Ownership**   Board/Steering
  Member**                  Witness**                               Committee**
  ----------- ------------- ------------------------- ------------- -----------------------
  Randal J.   Omron, Inc.   None                      None          None
  Thomas, MD,                                                       
  MS, FAHA                                                          

  Marjorie    None          None                      None          Healthways
  King, MD,                                                         
  FAACVPR,                                                          
  FACC                                                              

  Karen Lui,  None          None                      None          None
  RN, MS,                                                           
  FAACVPR                                                           

  Neil        None          None                      None          None
  Oldridge,                                                         
  PhD,                                                              
  FAACVPR                                                           

  Ileana L.   Novartis      AstraZeneca               None          Food and Drug
  Piña, MD,                                                         Administration (FDA)
  FACC                                                              

              National      Novartis                                 
              Institutes of                                         
              Health (NIH)                                          

  John        Amgen         None                      Health        Amgen
  Spertus,                                            Outcomes      
  MD, MPH,                                            Services      
  FACC                                                              

              Atherotech                              Outcomes      United Healthcare
                                                      Instruments   

              Roche                                                  
              Diagnostics                                           
  -----------------------------------------------------------------------------------------

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Sep

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, ACC/AHA Task
Force Members. AACVPR/ACC/AHA 2007 performance measures on cardiac
rehabilitation for referral to and delivery of cardiac
rehabilitation/secondary prevention services. J Cardiopulm Rehabil
Prev2007 Sep-Oct;27(5):260-90. \[74 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17885506)

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, American
Association of Cardiovascular and Pulmonary Rehabilitation/American.
AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for
referral to and delivery of cardiac rehabilitation/secondary prevention
services. Circulation2007 Oct 2;116(14):1611-42. \[74 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17885210)

Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J, Bonow RO,
Estes NA 3rd, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ,
Rumsfeld JS, Whitman GR, AACVPR, ACC, AHA, American College of Chest
Physicians, American College of Sports Medicine, American Physical
Therapy Association, Canadian Association of Cardiac Rehabilitation,
European Association for Cardiovascular Prevention and Rehabilitation,
Inter-American Heart Foundation, National Association of Clinical Nurse
Specialists, Preventive Cardiovascular Nurses Association, Society of
Thoracic Surgeons. AACVPR/ACC/AHA 2007 performance measures on cardiac
rehabilitation for referral to and delivery of cardiac
rehabilitation/secondary prevention services. J Am Coll Cardiol2007 Oct
2;50(14):1400-33. \[74 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17903645)

#### MEASURE AVAILABILITY

The individual measure, \"Performance Measure B-3C: Individualized
Assessment of Optimal Lipid Control,\" is published in \"AACVPR/ACC/AHA
2007 Performance Measures on Cardiac Rehabilitation for Referral to and
Delivery of Cardiac Rehabilitation/Secondary Prevention Services.\" This
article is available from the [American Association of Cardiovascular
and Pulmonary
Rehabilitation](http://www.aacvpr.org/crperformance_measures_jcrpsept07.pdf),
the [American College of
Cardiology](http://content.onlinejacc.org/cgi/content/full/j.jacc.2007.04.033v1),
and the [American Heart
Association](http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.185734)
Web sites.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on July 18, 2008. The
information was verified by the measure developer on September 3, 2008.

#### COPYRIGHT STATEMENT

**American Association of Cardiovascular and Pulmonary Rehabilitation
(AACVPR)**

AACVPR provides approval for hosting and downloading the document:
*AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for
Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention
Services*.

**American College of Cardiology Foundation/American Heart Association**

-   Permission does not include the ACC and AHA logos. This material
    cannot be used for resale, advertising, or promotional purposes.

-   Use of this material does not convey (or appear to convey) that the
    product or practice is produced or owned by the American College of
    Cardiology Foundation (ACCF) and/or has the endorsement of the
    ACCF/AHA.

-   Full acknowledgement of the original source must be accompanied by a
    copyright statement that includes all information encompassed in the
    following example: Reprinted \[Modified\] with permission from
    Thomas RJ, King M, Lui K, et al. AACVPR/ACC/AHA 2007 performance
    measures on cardiac rehabilitation for referral to and delivery of
    cardiac rehabilitation/secondary prevention services. J Am Coll
    Cardiol 2007;50:1400-33.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008