1. Introduction Results Conclusion
Web-based self-management system for cardiac rehabilitation
First results of the development
Anne-Marieke Wiggers, Sandra Vosbergen, Roderik Kraaijenhagen, Monique Jaspers, Niels Peek
Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands; j.m.wiggers@amc.uva.nl
The Dutch guidelines on Cardiac Rehabilitation
(CR) state that patients should receive an
individualised rehabilitation programme, built
up from four possible group-based therapies:
1. exercise training;
2. relaxation and stress management training;
3. education- and lifestyle change therapy;
4. different forms of individual counselling if
needed (e.g. by physical therapists,
psychotherapists, or dieticians).
During a visit in the clinic 80 to 130 data items
are required for a patient’s needs assessment
and therapy selection procedure.
Previously, an electronic patient record with
decision support facilities, called CARDSS, was
implemented in Dutch CR clinics to stimulate
implementation of the guidelines among CR
professionals.
1. For each data item it was decided
whether inclusion in MyCARDSS was
appropriate. The required clinical
measurements have to be available at
patients’ homes.
2. Interviews were conducted with
professionals in 3 CR clinics to gain insight into
the referral processes to CR, needs
assessment procedure, therapeutic decision
making, and actual rehabilitation.
3. These processes were subsequently
described in flowchart models.
4. It was analysed which changes to the
processes in the clinics are needed.
Several differences were found in the
care delivered by the 3 CR clinics:
1. Clinics varied in questionnaires used for
patients’ needs assessment (e.g. for anxiety
and depression).
2. Each clinic offered exercise therapy and
lifestyle change therapy, but varied in service
of other therapies.
3. Clinics varied in the number of disciplines
involved in CR.
Implementation of self-management systems
can increase the complexity of existing working
procedures. We are currently conducting a
pilot study with the system in clinical practice.
To allow patients
to complete the needs assessment
using a self management system
for cardiac rehabilitation (MyCARDSS)
at home.
No conflicts of interest to declare
Objective
Screenshot of a question from the alcohol questionnaire in the MyCARDSS system.
Translation: “On an average day, how much alcoholic drinks do you use? “
The generic workflow model
Methods
Post rehabilitation phaseRehabilitation phaseClinical phase
Cardiac
incident
Hospitalization
Visit at the
hospital
Multidisciplinairy
consultation
Start CR Evaluation
Follow-up
evaluation
Decisicion
CR
Hospital
appointment
scheduled for
CR
Questionnaires
were filled in at
home
Questionnaires
are taken over
in CARDSS
Yes
Therapyplan
out of
CARDSS
No
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