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UBC Theses and Dissertations

Selecting quality indicators for pulmonary rehabilitation programs in Canada : a modified RAND Appropriateness Method study Cheung, Walden A.


Pulmonary rehabilitation (PR) is a comprehensive intervention of self-management education and exercise training that improves quality of life, exercise tolerance, symptoms of dyspnea, and reduces the risk of hospitalization in patients living with chronic respiratory diseases such as chronic obstructive pulmonary disease, asthma, lung cancer, and interstitial lung disease. Despite the proven benefit of pulmonary rehabilitation, recent studies have found notable inconsistencies in its organization and delivery. Inconsistencies within clinical practice are likely to affect the quality in the delivery of pulmonary rehabilitation. Quality indicators (QIs) are tools similar to a checklist that can potentially remediate these concerns. While other jurisdictions have created quality indicators for pulmonary rehabilitation programs, their methodological approach to developing these quality indicators is questionable. This study developed 56 quality indicators with a rigorous approach using a modified RAND Appropriateness Method. A panel comprising twelve PR healthcare professionals and stakeholders was created to create a list of QIs. The panel rated each indicator based on four criteria (importance, scientific soundness, reliability, and feasibility) and listed which indicator they believed could determine a quality pulmonary rehabilitation program. This study recommends that the 56 QIs, based upon consensus, be used for operationalizing the evaluation and auditing of PR programs as well as for establishing clinical benchmarks.

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