Cardiac rehabilitation services
This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg40
2 An integrated approach to commissioning high-quality integrated cardiac rehabilitation
Commissioning cardiac rehabilitation services is fundamental to the wider commissioning strategy for cardiovascular disease and long-term conditions.
Commissioners should consider the whole care pathway for cardiovascular disease and long-term conditions when commissioning cardiac rehabilitation. They should also consider how cardiac rehabilitation services are integrated with primary care, secondary care and voluntary services and community services.
The long-term conditions workstream of the Quality, Innovation, Productivity and Prevention (QIPP) programme advocates a proactive generic management model of care for people with long-term conditions. Commissioners should ensure that people with cardiovascular disease and their carers have appropriate access to specialist, condition-specific information and support when indicated.
Commissioners should work with health and wellbeing boards, local authorities, primary care, acute and secondary care, community services and social care.
Commissioners should ensure joint working across health and social care using the generic long-term conditions model. They may also find the exemplar CQUIN goals on long-term conditions useful.
Commissioners may wish to work with service providers to carry out baseline assessment and clinical audit using NICE implementation support as follows:
This will enable commissioners to identify where recommendations from NICE clinical guidelines have been implemented and highlight areas for improvement.
The Department of Health's commissioning pack on cardiac rehabilitation describes cardiac rehabilitation along a best practice care pathway using stages 0 to 6 to reflect core stages in the cardiac rehabilitation pathway as follows:
Stage 0 Identify and refer patient
Stage 1 Manage referral and recruit patient to cardiac rehabilitation programme
Stage 2 Assess patient for cardiac rehabilitation
Stage 3 Develop patient care plan
Stage 4 Deliver comprehensive cardiac rehabilitation programme
Stage 5 Conduct final assessment
Stage 6 Discharge and transition to long-term management
This guide offers an indicative population benchmark for cardiac rehabilitation and focuses on the following service components for cardiac rehabilitation (see section 4):
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identification and referral
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maximising participation and completion
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delivery of programme
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long term-management
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developing high-quality cardiac rehabilitation.