Evaluation of provider support for a supervised exercise therapy protocol in patients with symptomatic PAD: A quality improvement project.

Background: Peripheral artery disease (PAD) affects more than 8 million individuals in the United States and many patients diagnosed with PAD are not receiving supervised exercise therapy which considered first line therapy in a program of comprehensive evidence-based care. This lack of evidence-based therapy can lead to reduced functional status, limited mobility, poor quality of life, and contribute to escalating healthcare costs in the population of patients with symptomatic peripheral artery disease.

Problem: An analysis conducted on the current treatment practices for patients with symptomatic PAD by practitioners at a private cardiology group practice in Eastern North Carolina revealed that supervised exercise therapy (SET) was not prescribed for their population of patients with PAD. The absence of an evidence-based guideline-directed SET protocol partnered with no operating vascular wellness program created variations in the treatment of patients diagnosed with symptomatic PAD. These variations can impact the quality of care delivery and outcomes of individuals diagnosed with PAD. The main purpose of this quality improvement project was to evaluate provider support in adopting an evidence-based SET protocol into current treatment practices of individuals with symptomatic PAD. This quality improvement initiative is relevant to other clinical venues as it may further define the role of gaining provider support through formal evaluative instruments of patient protocols such as SET to increase availability, access, and referrals of patients needing healthcare services.

Methods: A quality improvement initiative was implemented to determine if the practitioners in a private cardiology group practice in Eastern North Carolina would support the adoption of an evidence-based SET protocol into their current treatment practices for individuals with symptomatic PAD. Through the utilization of the best empirical evidence, a protocol for SET was developed. The SET protocol was then appraised by the private cardiology group practitioners using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.

Results: The utilization of the AGREE II tool by the cardiology practitioners demonstrated that the evidence-based SET protocol quality rating scores in all six domains were greater than seventy percent. All providers supported the recommended SET protocol using the AGREE II instrument (n = 5, 100%).

Conclusion: Success in provider support for the adoption of a SET protocol was the result of cardiology practitioners' appraisal of the evidence and vision to reduce the variation in current treatment practices of patients with symptomatic PAD. More investigation is needed across various healthcare systems to further evaluate provider support of SET protocols to further reduce variation in the treatment of patients with symptomatic PAD.