Pulmonary and Cardiac Telerehabilitation improving equitable access

Overview

Initiative type

Service Improvement

Status

Deliver

Published

June 2025

Summary

Improving access and reach to pulmonary and cardiac rehabilitation for regional and rural  Queenslanders through a virtual, flexible, networked and outcomes driven model.

Key dates

1 January 2022 - 30 June 2024

Project Partners

Involved in PaCT steering committee and in the co-design consultation for local corridors model of care and marketing/ resources were patient centred and fit for purpose.   Patient feedback sessions and consultation/ interviews has guided the local adaptations to the model to ensure sustainability.

Aim

To improve equitable access to pulmonary and cardiac rehabilitation by evaluating hub and  spoke telerehabilitation accessibility, safety and program outcomes in regional, rural and remote Queensland.

Outcomes

  • 536 participants referred across 7 HHSs.
  • 64% acceptance rate.
  • 87.3% of sessions delivered  outside a QH setting.
  • 53 spoke sites established.
  • 77% (n=264) of completers showed improvement in ≥one clinical measure.
  • All clinical outcomes met significant improvements.
  • Zero reported adverse training events. Hospital Utilisation (n = 343) 12 months  pre-and-post- completion:
  • Emergency presentations reduced by 24% (2.1±2.0 to 1.5±1.2, p < 0.002).
  • Av. length of stay decreased by 1.8 days 6.0±3.7 to 4.2±3.6 days (p < 0.002)
  • 14% of participants identified as Aboriginal and/or Torres Strait Islander.
    Patient travel savings 236, 287km and 2,380hours.
  • Timely access improved by 30% >28 days.
  • 47 upskilled clinicians
  • 95% of consumers rated 5/5 Likert for satisfaction

Background

Pulmonary and cardiac rehabilitation are essential, evidence-based interventions that
reduce hospital readmissions, improve functional outcomes, and enhance quality of life for people with chronic conditions [3-7]. Despite these known benefits, access across regional and remote Queensland has historically been limited due to workforce shortages,
travel burdens, and service fragmentation [8]. As a result, many Queenslanders—particularly those outside metropolitan areas—have been unable to participate in rehabilitation, perpetuating avoidable health inequities and hospital readmissions [9].

The COVID-19  pandemic further exposed these service gaps but also accelerated innovation in virtual models of care, including telerehabilitation. Queensland Health’s Telehealth Strategy 2021–2026 identified digital care as essential to improving rural access and system
sustainability [10]. PaCT (Pulmonary and Cardiac Telerehabilitation) was developed in this context to ensure Queenslanders, regardless of location, could access safe, timely, and high-quality rehabilitation close to home.

The central problem PaCT addressed  was this: How can we deliver consistent, evidence-based pulmonary and cardiac rehabilitation across diverse rural and remote Queensland communities without relying solely on centralised, metro-based models? Guided by national guidelines [3,4,11], virtual care  frameworks [10,12], and implementation science, PaCT provided a consistent but flexible rehabilitation model that could be adapted locally while maintaining fidelity to best-practice standards. Core program features include virtual delivery, structured education
and exercise, and local upskilled clinicians completing assessments.

Over two years, PaCT has become embedded in 7 Hospital and Health Services, supported by a statewide advisor roles, digital tools, and shared learnings. The model allows consumers to receive  safe multidisciplinary rehabilitation at home, reducing barriers and improving continuity of care after hospitalisation [3,5]. Importantly, it has also contributed to emerging evidence on virtual models of chronic disease management in the Australian context.
[1,4,7]

Methods

The Pulmonary and Cardiac Telerehabilitation (PaCT) program was implemented to enhance access to rehabilitation services for individuals with chronic heart and lung conditions in regional, rural and remote Queensland. The program’s design was informed by project findings of the Statewide Pulmonary Rehabilitation Project 2020-2021, Queensland  Health’s Cardiac and Pulmonary Telerehabilitation Guideline, Networked Care and the Telehealth Strategic Vision 2021–2026, emphasizing virtual care delivery and equitable access. PaCT offered a biweekly six-to-eight-week, hybridised rehabilitation program  delivered via Virtual Care platform.

The program included individualized exercise prescriptions, education sessions, and self-management support, facilitated by multidisciplinary teams. Implementation followed a phased approach across seven Hospital and Health  Services (HHSs). Key initiatives included:

  • Local Adaptation: Each HHS tailored the program to their specific context, considering local resources and patient needs.
  • Workforce Development: Clinicians received training in telehealth delivery and participated  in communities of practice to share experiences and best practices.
  • Technology Utilization: Secure, Queensland Health-supported telehealth platforms were employed to ensure patient confidentiality and data security. Data were analysed quarterly, and findings  informed iterative refinements to the program. A centralized dashboard facilitated real-time monitoring to meet referral activity and benchmarking.

The evaluation will be underpinned by the RE-AIM conceptual model that uses six domains to assess the effectiveness  of a program: design and establishment, reach, effectiveness, adoption, implementation and maintenance.  An interim evaluation of the model was completed in October 2023 and Year 2 evaluation was completed in October 2024.

Discussion

Whilst the project implementation has now transition to business-as-usual care, the  evaluation focused on the feasibility and progress over two years of the project, provided many key findings, lessons learnt and opportunities to inform future rollout across sites or similar programs in Queensland. Success factors included a flexible yet  standardised model, the use of local clinical champions, a supportive virtual learning environment, and robust data collection embedded from the start. This created both accountability and opportunity for innovation.

Strengths:

  • Investment in building stakeholder  trust and demonstrating sustainable commitment is critical to success.
  • Strong alignment with statewide and national guidelines and care standards on virtual care and cardiorespiratory rehabilitation.
  • Demonstrated improvement in access, clinical outcomes,  and consumer experience
  • Empowering clinicians and existing services through upskilling and extended reach via innovative options for care delivery closer to home.
  • Scalable iterative model that balances consistency with contextualisation

Challenges and  Limitations:

  • Variation in digital literacy among consumers and clinicians
  • Connectivity issues in very remote areas
  • Engagement of some consumer and clinician groups remained variable, despite targeted outreach Opportunities:
  • Full integration with existing  PR/CR services and other chronic disease programs
  • Strengthening partnerships with ACCHOs, NGOs, private health services, GP and Primary Health Networks
  • Embedding in discharge pathways from hospitals to prevent readmissions
  • Expanding use of PROMs to guide  personalised care and evaluation Next Steps:
  • Should funding be sourced, phased expansion within all 16 HHSs with dedicated workforce
  • Embed the PaCT model and upskilling process as an option for care within all cardiorespiratory rehabilitation. Translational
    learnings for other chronic disease management services.
  • Advance integration with Virtual Hospital, Digital Front Door and other virtual platforms
  • Tailor cultural safety and access pathways for First nations communities through co-design.

References

1. Alison J et al. Australian and New Zealand Pulmonary Rehabilitation Guidelines, Respirology,  2017, 22, 800-819.

2. Astley CM et al. The impact of cardiac rehabilitation and secondary prevention programs on 12-month clinical outcomes: a linked data analysis. Heart Lung Circ 2020;29:475–482

3. Australian Commission on Safety and Quality in Health Care.  Chronic Conditions and Integrated Care. ACSQHC; 2021

4. Woodruffe S, et al. Australian Cardio-vascular Health and Rehabilitation Association (ACRA) Core Components of Cardiovascular Disease Secondary Prevention and Cardiac Rehabilitation 2014. Heart, Lung
and Circulation.

5. Driscoll et al (2020). Estimating the health loss due to poor engagement with cardiac rehabilitation in Australia. International Journal of Cardiology. 317 pp7-12.

6. Ambrosetti., M. et al (2020). Secondary prevention through comprehensive  cardiovascular rehabilitation: From knowledge to implementation. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology, Volume 28, Issue 5,  May 2021, Pages 460–495, https://doi.org/10.1177/2047487320913379

7. Hug S et al. 2024. Quantifying uptake and completion of pulmonary rehabilitation programs in people with chronic obstructive pulmonary disease known to tertiary care. Chron Respir Dis.21.

8. Queensland Health. Rural and Remote Health Services Framework 2022–2027.

9. TSANZ. Position Statement on Pulmonary Rehabilitation, Thoracic Society of Australia and New Zealand, 2022

10. Queensland Health. (2022) The Statewide Pulmonary Rehabilitation Project:
Evaluation Report. Retrieved from: Queensland Respiratory and Sleep Clinical Network | Queensland Health Intranet on 10 April 2025.

11. Queensland Health. (2022). Cardiac and pulmonary telerehabilitation – Queensland Health Guideline. Retrieved from Cardiac
and pulmonary telerehabilitation guideline (health.qld.gov.au) on 8th April 2025.

12. Queensland Health. Telehealth Strategic Vision 2021–2026.

13. Digital Health CRC & Australian Healthcare and Hospitals Association. Virtual Care in Australia: A Framework  for Quality Virtual Care. 2021

14. Field P, Franklin RC, Barker R, Ring I, Leggat P, Canuto K. Importance of cardiac rehabilitation in rural and remote areas of Australia. Aust J Rural Health. 2021; 30:149–63.

15. Queensland Health. Performing a Six Minute  Walk Test PMWT. Retrieved January 2023 from Performing a Six Minute Walk Test (PMWT) - Courses - Central (csds.qld.edu.au)

16. Department of Health Queensland (2025). The Health of Queenslanders 2025. Report of the Chief Health Officer. Accessed 16/4/24 From
the CHO | Report of the Chief Health Officer Queensland.

17. Walsh JR et al. Longevity of pulmonary rehabilitation benefit for chronic obstructive pulmonary disease – health care utilisation I the subsequent 2 years. BMJ Open Respiratory Research 2015;6:e000500.
doi:10.1136/bmjresp-2019-000500

18. Jones, Arwel W et al. “Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD.” ERJ open research vol. 3,1 00089-2016. 30 Jan. 2017, doi:10.1183/23120541.00089-2

Key contact

Nadia Nestor

Statewide Pulmonary Rehabilitation Program Advisor

Metro North Hospital and Health Service

Email:  nadia.nestor@health.qld.gov.au

Last updated: June 2025

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