Develop an intervention to optimise the health outcomes of a population group determined by the module convenor.

Develop an intervention to optimise the health outcomes of a population group determined by the module convenor.

You must utilise appropriate intervention tools and/or frameworks that you have been introduced to over the course of the module, for example intervention mapping, to plan and design the intervention. You must also ensure the development of your intervention is underpinned by scientific literature.
Focus:

In response to an authentic scenario (separate document), you will propose a revised cardiac rehabilitation programme for a local hospital to help optimise the health outcomes of their patients. You will base your change objectives and intervention design on the cardiac rehabilitation team requirements, but also on the evidence base.

Word limit:

3000 words maximum (not inclusive of figure and table legends and references)

Format:

Written, using Harvard style referencing, include page numbers and section headings, ARIAL 12
Framework Provide an evidence-based justification for your intervention utilising the steps and tasks of the Intervention Mapping framework. LINK here https://interventionmapping.com/

Introduction (10%)

• Provide the context for the proposal by providing a concise but informative and evidence-based overview of the epidemiological picture of cardiovascular disease CVD at a national and local level. Aim to provide relevant evidence-based insights into the health status of the Blackpool population, whilst highlighting the need to optimise health outcomes in this cardiac rehabilitation CR population.

• Provide an overview of how the current CR situation at Blackpool aligns to the national CR picture, whilst acknowledging some key health inequalities and evidence that may inform and justify your redesign.
• A brief rationale for intervention mapping as the framework to redesign CR in Blackpool. This will help flow into next section.

Intervention Mapping Step 1 (20%)

1. Planning group and needs assessment – the scenario provides the information for this step.

2. Identify the problem(s) and complete a logic model of the problem – ensure this is described in the context of the population, setting and community/environment.

3. Complete the asset assessment table
4. State programme goals

Intervention Mapping Step 2 (20%)

Use subheadings for behavioural and environmental tasks. Focus on developing these to relate specifically to the scenario and make links to step 1.

1. Behavioural
a. Expected Outcomes
b. Performance Objectives
c. Determinants
2. Environmental
a. Expected Outcomes
b. Performance Objectives
c. Determinants
3. Change objectives

a. You can attempt change matrices and a logic model of change but these take time and therefore are not expected. Inclusion of them will not guarantee higher grades. As it is not an expectation, you will not lose marks if they are not included.

b. However, you might find developing the change matrices will allow you to include 1abc and 2abc into a table in the appendices.

Intervention Mapping Step 3 (40%)

This should be the most comprehensively written part of your proposal as you utilise the step 2 work to lay out the redesigned programme plan.

• This must include evidence-based justifications for your change methods, whilst keeping the scenario and CR teams’ requests in mind.

• Make some mention to behaviour change and the social-ecological model (where relevant)

• Make sure in this section you address the measurement tools/approaches that will aid a future evaluation, and note when they will be done, whilst also noting the implications of these for the CR programme e.g. pre and post fitness assessments.

You can use the below subheadings based on the intervention mapping (IM) tasks but this may impact the logical flow and progression of your writing.

a. Programme themes and components
b. Scope – breadth and amount of intervention
c. Sequence – what is the order your components will be delivered? What is the duration?
d. Change methods
e. Practical applications to deliver change methods

You do not need to do Step 4 – 6, but you may want to ensure the reader is convinced that your intended participant (CR patients) will be able to interact with the programme, and the implementers will be able to deliver it.

Final statement

Provide a short summary of your intended programme to tackle the identified determinants in order to meet the programme goals. No more than 150 words.

References

Provide a full reference list in accordance with Harvard style of referencing.

Appendices

Make use of appendices and ensure you include:

1. Scenario
2. Logic model of the problem (template provided)
3. Asset assessment table (template provided)

• Ensure each appendix has a separate number and they must be referred to in the main document. The appendices are not included in your word count.
• Ensure any tables have a title at the top “Table 1: Asset Assessments.”
• Ensure any figures have a title at the bottom “Figure 1: Logical model of the problem”

Scenario

Blackpool Victoria Hospital is the location of the North West’s leading Cardiac Centre.
Blackpool has one of the UK’s highest rates of cardiovascular disease and associated cardiac events, alongside vast health and social inequalities, placing increased demand on the Cardiac Centre to prevent, manage and treat CVD in its community.

The Cardiac Centre is also the home to a highly committed cardiac rehabilitation (CR) team, who lead outpatient CR sessions (Phase III) in accordance with the BACPR and ACPICR guidelines. The team is led by cardiac specific physiotherapists, with assistance from nurses and occasionally from CR exercise instructors, but they typically feature in Phase IV.

The Phase III CR Programme runs within the Cardiac Centre and due to funding cuts the CR service has reduced from three sessions to two sessions per week (this happened 18 months ago). The sessions are run in a small exercise facility and they are currently unable to conduct any baseline fitness assessment using an exercise tolerance test or CPET.

When possible, they perform a 6-minute walk test (6-MWT) or an Intermittent Shuttle Walk Test (ISWT) but this is not consistent and they rarely do post-CR fitness assessments. In light of recent CR research suggesting UK-based CR is ineffective at improving health outcomes and mortality, the team are concerned and lacking confidence that their CR sessions are making a difference.

Since reducing to twice weekly sessions, the CR team have made a number of anecdotal observations that demonstrate the service does not seem to be meeting its intended aims and outcomes.

The following observations were shared with the Clinical Commissioning Group:

• Patients don’t appear to be getting fitter and therefore there is a major concern that there will be no/limited improvement to their health and mortality.

• Patients are not as well-informed about making positive steps to improve their lifestyle as would be expected upon completion of the 8-week intervention.

• There have been a number of readmissions following a subsequent cardiac event so this does concern the team that the CR sessions are not reducing risk of recurring events.

• They have increasing patients on the waiting list, which is leading to a delay in the optimal timeframe to start CR and therefore negatively impacting on health outcomes.

The CCG have increased funding so the CR team are now in a situation where they need to find solutions to ensure patients are starting CR in the recommended timeframe and receiving the most effective dose to optimise their health outcomes.

Can you re-design their CR intervention to offer more effective CR to the Blackpool community?

The questions for you to consider are:

• Do we keep patients attending twice weekly for an 8-week CR intervention and deal with a growing waiting list?

• Do we reduce the exercise dose to once weekly so we can increase the number of patients entering CR and reduce the waiting list?

• Is there anything we can do to the hospital-based CR to make it more effective?

• Is there anything we could do to offer additional sessions outside of the hospital setting so our patients meet the BACPR recommendations?

• Are there any suggestions for altering the educational aspects to be more effective at encouraging our patients to make and adhere to healthier lifestyle choices?

• How can we determine the effectiveness and success of our CR programme to ensure we can make a difference and optimise the health outcomes of our cardiac patient population?

Useful papers

Standards and core components for cardiovascular disease prevention and rehabilitation Aynsley Cowie,1 John Buckley,2 Patrick Doherty,3 Gill Furze,4 Jo Hayward,5 Sally Hinton,6 Jennifer Jones,7 Linda Speck,8 Hasnain Dalal,9 Joseph Mills,10 on behalf of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR)

Cardiac rehabilitation OPEN ACCESS Hasnain M Dalal honorary clinical associate professor 1 , Patrick Doherty chair in cardiovascular health, director of the National Audit of Cardiac Rehabilitation, deputy head of department (research) 2 , Rod S Taylor chair of health services research, academic lead for Exeter Clinical Trials Support Network, NIHR senior investigator 3 1University of Exeter Medical School (primary care), Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK; 2Department of Health Sciences, University of York, York YO10 5DD, UK; 3 Institute of Health Research, University of Exeter Medical School, Exeter EX1 2LU, UK

The BACPR Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation 2017 (3rd Edition)

The National Audit of Cardiac Rehabilitation bhf.org.uk Quality and Outcomes Report 2019

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