Canada has an opportunity to address antimicrobial resistance through COVID-19 recovery spending.

Antimicrobial Resistance (AMR) causes more than a million deaths globally per year due to infections incurable with currently available antibiotics. Failing to effectively address AMR will have significant negative consequences for Canadians and the Canadian economy. Canada is behind on allocation of required funding and nationally coordinated AMR mitigation strategies relative to other high-income countries. A Pan-Canadian AMR action plan and development of a new governance model is pending. Recent AMR-specific funding commitments are significant but fall short while distribution of funds indicate a siloed approach. Canada could initiate progress towards AMR mitigation through incorporation within the scope of budget allocations intended for COVID-19 recovery and mitigation efforts. We discuss the following components for inclusion: development of infectious disease diagnostics and therapeutics; antimicrobial stewardship interventions in long-term care and Indigenous communities; environmental monitoring of AMR; comprehensive antimicrobial use, and AMR surveillance; and support for capacity-building in low and middle-income countries.

Quality and Variability of Cardiovascular Rehabilitation Delivery: APPLYING THE CANADIAN QUALITY INDICATORS.

PURPOSE: Cardiac care, including cardiovascular rehabilitation (CR), is most effective if it is high-quality. The aim of this study was to describe CR quality, using the recently developed Canadian Cardiovascular Society CR quality indicators (QIs). Difference in quality between CR sites was also assessed. METHODS: Secondary analysis was conducted on an observational, prospective, multisite CR program evaluation cohort. A convenience sample of patients from 1 of 3 CR programs was approached at their first CR visit, and consenting participants completed a survey. Clinical data were extracted from charts pre- and postprogram. Of the 30 CR QIs, 21 (70.0%) were assessable: 10 process, 9 outcome, and 2 structure QIs. RESULTS: Of 411 consenting patients, 209 (53.0%) completed CR. The greatest quality was observed for assessment of blood pressure (98.1%), communication with primary health care at CR discharge (94.2%), and patient enrollment (94.0%). The lowest quality was observed for wait time from hospital discharge (9.2%), assessments of blood glucose (42.1%), and lipid control (53.0%). Of the 7 QIs that had an established benchmark, quality for 2 (28.6%) was above the benchmark (particularly assessment of blood pressure). Significant between-site differences were observed in 11 (64.7%) QIs. The magnitude of quality differences between sites was largest for assessment of lipid control (72.6%), assessment of blood glucose control (69.0%), and wait time in median days from referral to enrollment (30.6 days). CONCLUSION: There is wide variability in CR program quality, both overall and between CR sites. Quality improvement in particular aspects of CR care is required.

The quality of cardiac rehabilitation in Canada: a report of the Canadian Cardiac Rehab Registry.

Cardiac rehabilitation (CR) significantly reduces morbidity and mortality compared with usual care. CR quality indicators (QIs) have recently been established in Canada. This article presents an assessment of real-world CR program achievement of process and outcome QIs in Canada, using the Canadian Cardiac Rehab Registry (CCRR). The CR QIs were developed through the Canadian Cardiovascular Society's Best Practice Methodology. After reconciling the QI with CCRR definitions, it was identified that 14 (46.7%) of the 30 QIs could be assessed through the CCRR. There were 5447 patient records from 11 CR programs in the CCRR. Wait times exceeded the 30-day QI target, at a median of 84 days from referral to enrollment. Assessment of QIs of blood pressure (90%) and adiposity (85%) were high, however assessment of QIs for lipids (41%), blood glucose among patients with diabetes (23%), and depression overall (13%) were low. A majority of the participants (68%) achieved the half metabolic equivalent increase in the exercise capacity QI from CR program entry to exit. Of smokers, only 61% were offered smoking cessation therapy. Thirty percent of participants were offered stress management. The CR program completion QI was met in 90% of patients. Areas for care and quality improvement have been identified for the CR community in Canada. Efforts to engage more CR programs assess a greater number of QIs, and to feed back the findings to participating programs quarterly are currently under way.

Pan-Canadian development of cardiac rehabilitation and secondary prevention quality indicators.

The Canadian Cardiovascular Society (CCS) is implementing the Canadian Heart Health Strategy and Action Plan recommendation to build knowledge infrastructure, through its Data Definitions and Quality Indicator (QI) project. The CCS selected cardiac rehabilitation (CR) and secondary prevention as a content area for QI development. In accordance with the CCS QI Best Practice Methodology, rapid reviews of the literature were conducted. A long list of 37 QIs, in the areas of structure, process, and outcome were developed. Through an online survey, 26 (42%) of all contacted external experts rated each QI on importance, scientific acceptability, and feasibility, using a 7-point scale. The overall mean rating was 5.4 ± 1.4. Through a consensus process, the working group excluded 8 QIs based on this feedback, and several others were revised. A 30-day Web consultation was then undertaken, to solicit input from the broader CCS and CR community. A "top 5" list of QIs was requested by the CCS, which were: (1) inpatients referred to CR; (2) wait times from referral to CR enrollment; (3) patient self-management education; (4) increase in exercise capacity; and (5) emergency response strategy. Knowledge translation activities are now under way to promote utilization of the QIs and ultimately improve CR care.