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Cardiac Rehabilitation: Implementing New Assessment Tools

Crozer-Keystone’s Cardiac Rehabilitation nurses attend an annual conference conducted by nursing enrichment consultant Patricia Comoss, who advises the program on new developments and assists with recertification preparation. This consultation led directly to a change in how our nurses evaluate a patient’s functional capacity.

Since August 2010, patients have been asked to walk back and forth over a 100-foot long space for six minutes at the beginning and end of rehabilitation, and the distances are compared. This is considered a more effective indicator than other methods.

According to CKHS Cardiac Rehab nurse Geri Edwards, RN, BSN, BC, the goal is to see improvement, which they do, whether the patient is using a walker or covering ground easily. She notes that a positive change provides psychological as well as physical benefits, which is an important part of rehabilitative progress.

The six-minute walk is just one way in which our Cardiac Rehab nurses utilize external information to evaluate patients’ progress. The program also uses a quality of life assessment tool developed by Dartmouth College that asks patients to rank the following from 1 (“better”) to 5 (“worse”): physical fitness, emotional feelings, daily activities, social activities, pain, change in health, overall health, social support and overall quality of life. Over the course of rehabilitation in 2009, patients’ overall quality of life ranking improved 24 pecent (from 2.2 to 1.7), while their ranking of physical fitness improved 38 perent (from 4.1 to 2.5). 

Professional groups also provide information by alerting nurses to proposed legislation that can impact patient care. For example, patients’ participation in rehabilitation and their outcomes can be adversely affected if co-pays are high or if covered sessions are limited. When informed of pending legislation by American Association of Cardiovascular and Pulmonary Rehabilitation [AACVPR] or the Tristate Society of Cardiovascular and Pulmonary Rehabilitation, our nurses have an opportunity to contact their representatives.

In Fall 2010, for instance, AACVPR issued a call to action for members to support increased Medicare coverage for physicians and non-physician cardiac rehab practitioners. Previously, this type of networking has been used to petition Medicare to expand rehabilitation coverage to patients who have had cardiac stents inserted to prevent heart attacks, as well as heart valve replacement and heart transplantation. It has also led to Medicare extending the time over which a patient may use rehabilitation coverage (to 36 weeks, from 12), though it has not increased the number of covered visits during the period.