The ClaudicationNet concept: design of a national integrated care network of supervised exercise therapy for patients with intermittent claudication

CONTEXT: Intermittent claudication is a manifestation of peripheral arterial disease. The primary and most effective intervention is exercise therapy. When exercise therapy is supervised by a physical therapist, superior results on walking distance and quality of life have been found (Level I). Caregivers like physical therapists, vascular surgeons and general practitioners should collaborate in regional integrated care networks. CASE DESCRIPTION: ClaudicationNet aims to implement nationwide coverage of regional networks for supervised exercise therapy. Participating physical therapists comply with a progressive set of quality markers. Over a period of five years a fully transparent and high quality care, evaluated by quality indicators, should be achieved. This new standard of integrated care will also hold lifestyle interventions. Results of maximal walking ability, quality of life, comorbidities, lifestyle parameters and cardiovascular risk factors will be gathered in a national database as well as reported back to referring physicians. PRELIMINARY CONCLUSIONS: ClaudicationNet is supported by The Dutch Society for Vascular Surgery, the Royal Dutch Society for Physical Therapy and the Dutch cardiovascular patient association. For 2012, supervised exercise therapy is determined as a mandatory key performance indicator for vascular surgeons. The first regional networks are enrolled and our multicenter study results show progression in walking distance and quality of life for patients treated with this novel integrated care concept compared to usual care. DISCUSSION: Achieving national implementation is dependant on several critical success factors. Vascular surgeons need to refer to this new group of specialised physical therapists. A particular role must also be played by the Joint Dutch Health Care Insurers Association. In collaboration, we aim to develop a system that rewards only those physical therapists who perform excellent care.