Participant characteristics and response rate
The questionnaire was sent to 1,303 participants, namely 31 directors of hospitals that performed PCI and CR, 13 directors of hospitals with regional centers, 117 directors of hospitals that performed PCI but not CR, 408 directors of hospitals that did not perform PCI, and 23 civil servants belonging to public agencies. A total of 132 participants submitted the completed questionnaires, with a response rate of 22.30% (Table 1).
Table 1
Survey candidate and response
|
Candidate
|
response
|
Response rate (%)
|
PCI, CR
|
31
|
13
|
41.94
|
CCRC
|
13
|
4
|
30.77
|
PCI, Non-CR
|
117
|
26
|
22.22
|
Non-PCI
|
408
|
67
|
16.42
|
Government Officer
|
23
|
22
|
95.65
|
Total
|
592
|
132
|
22.30
|
PCI, percutaneous coronary intervention; CR, cardiac rehabilitation; CCRC, cardiocerebrovascular rehabilitation center
Differences in organization-wise perception of CR
There were differences in the perceptions among organizations regarding the target diseases (Q4; p=0.010) and the roles of governmental health policies for CR (Q10, 11, 12; p=0.000). In particular, responses to Q11 (roles of governmental health policies for CR) were generally negative among directors of regional cardiocerebrovascular centers (2.50, 2.00-3.75), directors of hospitals that performed PCI but not CR (3.00, 3.00-4.00), and health policy personnel (3.00, 3.00-3.00). The details are shown in Table 2.
Table 2
Comparison of reply for each survey item according to characteristics.
|
PCI, CR
(n=13)
|
CCRC
(n=4)
|
PCI, Non-CR (n=26)
|
Non-PCI
(n=67)
|
Government Officer
(n=22)
|
p
|
Q1
|
5.00(4.50, 5.00)
|
4.50(4.00, 5.00)
|
4.00(4.00, 5.00)
|
5.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
0.160
|
Q2
|
5.00(4.00, 5.00)
|
4.50(4.00, 5.00)
|
4.00(4.00, 5.00)
|
5.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
0.207
|
Q3
|
5.00(4.00, 5.00)
|
4.50(3.25, 5.00)
|
4.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
0.534
|
Q4
|
4.00(4.00, 4.50)
|
4.50(4.00, 5.00)
|
4.00(3.00, 5.00)
|
5.00(4.00, 5.00)
|
4.00(3.00, 4.25)
|
0.010*
|
Q5
|
2.00(2.00, 3.00)
|
2.00(2.00, 2.75)
|
2.50(2.00, 3.00)
|
3.00(2.00, 4.00)
|
2.00(2.00, 3.25)
|
0.103
|
Q6
|
4.00(4.00, 5.00)
|
4.00(3.25, 4.75)
|
4.00(3.00, 4.00)
|
4.00(4.00, 5.00)
|
4.00(4.00, 4.25)
|
0.106
|
Q7
|
5.00(4.00, 5.00)
|
4.00(3.25, 4.75)
|
4.00(3.00, 4.00)
|
4.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
0.134
|
Q8
|
5.00(4.00, 5.00)
|
4.50(4.00, 5.00)
|
4.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
0.331
|
Q9
|
4.00(4.00, 5.00)
|
4.00(3.25, 4.75)
|
4.00(3.75, 4.25)
|
4.00(4.00, 5.00)
|
4.00(3.75, 5.00)
|
0.774
|
Q10
|
5.00(5.00, 5.00)
|
4.00(3.25, 4.75)
|
4.00(4.00, 5.00)
|
5.00(4.00, 5.00)
|
4.00(3.00, 4.00)
|
0.000*
|
Q11
|
4.00(3.00, 5.00)
|
2.50(2.00, 3.75)
|
3.00(3.00, 4.00)
|
4.00(3.00, 5.00)
|
3.00(3.00, 3.00)
|
0.001*
|
Q12
|
5.00(4.00, 5.00)
|
4.00(3.25, 4.00)
|
4.50(4.00, 5.00)
|
4.00(4.00, 5.00)
|
4.00(3.00, 4.00)
|
0.001*
|
Q13
|
4.00(3.50, 5.00)
|
4.00(2.50, 4.75)
|
4.00(3.00, 4.25)
|
4.00(3.00, 5.00)
|
4.00(3.00, 4.00)
|
0.784
|
Q14
|
4.00(3.00, 5.00)
|
4.00(4.00, 4.75)
|
4.00(3.00, 5.00)
|
4.00(3.00, 4.00)
|
3.50(3.00, 4.00)
|
0.226
|
Q15
|
5.00(4.00, 5.00)
|
4.00(4.00, 4.75)
|
4.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
4.00(4.00, 5.00)
|
0.463
|
PCI, percutaneous coronary intervention; CR, cardiac rehabilitation; CCRC, cardiocerebrovascular rehabilitation center; Values describe as median (interquartile range)
Differences in perception of CR based on organizational characteristics
Differences in perception about measures to promote CR between directors of hospitals that did and those that did not perform PCI
Directors of hospitals that did not perform PCI agreed more to Q4 (target diseases for CR; p=0.012), Q5 (patients’ roles in CR; p=0.020), Q6 (hospitals’ roles in CR; p=0.031), and Q11 (roles of governmental health policies in CR; p=0.037) than those of hospitals that performed PCI. Responses to Q5 (patients’ roles in CR) significantly differed (p=0.020) between directors of hospitals that performed PCI (2.00, 2.00-3.00) and those that did not (3.00, 2.00-4.00; Figure 1).
Differences in perception about measures to promote CR between directors of hospitals that had and those that did not have a CR system
Although insignificant, directors of hospitals with CR systems perceived a higher need for Q1 (effectiveness of CR; p=0.061), Q5 (patients’ roles in CR; p=0.055), Q7 (hospitals’ roles in CR; p=0.065), and Q8 (hospitals’ roles in CR; p=0.063) than their counterparts of hospitals without CR systems. Responses to Q5 (patients’ role in CR) indicated a tendency for directors of hospitals without CR systems to place more weight on the patients’ role (3.00, 2.00-4.00) than those of hospitals with a CR system (2.00, 2.00-3.00; Figure 2).
Differences in perception about measures to promote CR between hospital directors and civil servants
Hospital directors perceived a significantly greater need for Q4 (target diseases for CR; p=0.015), Q10, Q11, Q12, and Q14 (roles of governmental health policies in CR; p=0.000, 0.003, 0.000, and 0.028, respectively) when compared with civil servants. In particular, civil servants indicated low agreement with most statements about the roles of governmental health policies compared with hospital directors. Further, personnel from both hospitals and public organizations indicated negative responses to patients’ roles in promoting CR (Figure 3).
Differences in perception about measures to promote CR between directors of hospitals that did and those that did not have a CR system
The responses among three groups were compared using an analysis of variance (ANOVA), and there were significant differences in the responses to Q4 (target diseases for CR; p=0.003), Q5 (patients’ roles in CR; p=0.031), Q10 (roles of governmental health policies in CR; p=0.000), Q11 (roles of governmental health policies in CR; p=0.001), and Q12 (roles of governmental health policies in CR; p=0.001) among the groups. The responses to Q5 significantly differed among the directors of hospitals that performed PCI (2.00, 2.00-3.00), directors of hospitals that did not perform PCI (3.00, 2.00-4.00), and civil servants (2.00, 2.00-3.25; Figure 4).
Only questions with significantly different responses among the groups in ANOVA were further analyzed with post hoc tests. Responses to Q4 significantly differed between directors of hospitals that did and those that did not perform PCI (p=0.012) and between civil servants and hospitals that did not perform PCI (p=0.003). Responses to Q10 significantly differed between civil servants and hospitals that performed PCI (p=0.001) and civil servants and hospitals that did not perform PCI (p=0.000). Responses to Q11 significantly differed between directors of hospitals that did and those that did not perform PCI (p=0.037) and hospitals that did not perform PCI and civil servants (p=0.000). Responses to Q12 significantly differed between civil servants and hospitals that performed PCI (p=0.001) and civil servants and hospitals that did not perform PCI (p=0.000). The details are shown in Table 3.
Table 3
Multiple comparisons test of Kruskal Wallis test of PCI, non-PCI, Government Officer
Dependent Variable
|
PCI(1) vs.
non-PCI(2) vs.
Government Officer(3)
|
N
|
M(Q1-Q3)
|
Mean rank
|
p-value
|
Q4
|
1-2
|
1
|
43
|
4.00(4.00-5.00)
|
46.78
|
.012*
|
2
|
67
|
4.00(5.00-5.00)
|
61.1
|
1-3
|
1
|
43
|
4.00(4.00-5.00)
|
34.78
|
.245
|
3
|
22
|
3.00(4.00-4.25)
|
29.52
|
2-3
|
2
|
67
|
4.00(5.00-5.00)
|
49.29
|
.003*
|
3
|
22
|
3.00(4.00-4.25)
|
31.93
|
Q5
|
1-2
|
1
|
43
|
2.00(2.00-3.00)
|
47.09
|
.020
|
2
|
67
|
3.00(2.00-4.00)
|
60.9
|
1-3
|
1
|
43
|
2.00(2.00-3.00)
|
33.55
|
.729
|
3
|
22
|
2.00(2.00-3.25)
|
31.93
|
2-3
|
2
|
67
|
3.00(2.00-4.00)
|
47.85
|
.060
|
3
|
22
|
2.00(2.00-3.25)
|
36.32
|
Q10
|
1-2
|
1
|
43
|
4.00(5.00-5.00)
|
53.62
|
.578
|
2
|
67
|
4.00(5.00-5.00)
|
56.71
|
1-3
|
1
|
43
|
4.00(5.00-5.00)
|
38.06
|
.001*
|
3
|
22
|
3.00(4.00-4.00)
|
23.11
|
2-3
|
2
|
67
|
4.00(5.00-5.00)
|
50.71
|
.000*
|
3
|
22
|
3.00(4.00-4.00)
|
27.61
|
Q11
|
1-2
|
1
|
43
|
3.00(3.00-4.00)
|
47.97
|
.037*
|
2
|
67
|
3.00(4.00-5.00)
|
60.34
|
1-3
|
1
|
43
|
3.00(3.00-4.00)
|
35.78
|
.078
|
3
|
22
|
3.00(3.00-3.00)
|
27.57
|
2-3
|
2
|
67
|
3.00(4.00-5.00)
|
50.26
|
.000*
|
3
|
22
|
3.00(3.00-3.00)
|
28.98
|
Q12
|
1-2
|
1
|
43
|
4.00(4.00-5.00)
|
56.43
|
.787
|
2
|
67
|
4.00(4.00-5.00)
|
54.9
|
1-3
|
1
|
43
|
4.00(4.00-5.00)
|
38.44
|
.001*
|
3
|
22
|
3.00(4.00-4.00)
|
22.36
|
2-3
|
2
|
67
|
4.00(4.00-5.00)
|
50.11
|
.000*
|
3
|
22
|
3.00(4.00-4.00)
|
29.43
|
PCI, percutaneous coronary intervention; *, p<0.017 by Mann Whitney U test