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final report (german)



Anne Michel

Susanne Schleicher

Dr. med. Sabine Stamm-Balderjahn


Charité – Universitätsmedizin Berlin

Abteilung Versorgungssystemforschung und

Grundlagen der Qualitätssicherung

in der Rehabilitation

Luisenstr. 13A, 10117 Berlin

Tel.: 030 450 517 109

Fax: 030 450 517 932

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Effectiveness of manual-based target agreements in CHD patients – An instrument for improving health behaviour in phase III rehabilitation – the CARO-PRE study

A goal of cardiac rehabilitation is to impart patients with a positive health behaviour and contribute to them also retaining this after the rehabilitation.

In the study, it is examined whether a joint agreement of goals between physician and cardiac patient improves the health behaviour following discharge from rehabilitation. To support this process, a target agreement concept was developed. The intention of this concept is to make a joint agreement between physician and patient. In addition, the patients receive supportive materials such as patient information and a patient passport. The goals, which are agreed upon in a structured therapeutic dialogue at the end of the rehabilitation, comprise, among other things, aspects of physical activity, healthy nutrition, tobacco abstinence and regular intake of medication in line with the medical prescription. It is important within this concept that the agreed goals are oriented to the individual situation of the patients and their individual needs, i.e. that the patients are involved in the target agreement on an equal footing. The study is geared towards patients suffering from coronary heart disease.


Project leader:

Dr. Karla Spyra


Running time of the project:

01.03.2008 – 31.12.2012



Cardiac rehabilitation is confronted with the problem of initiating changes in patients’ health behaviour and contributing to the consolidation thereof. To support this process, the establishment conducting the research developed a target agreement concept, the main component of which is a structured therapeutic dialogue at the end of phase II rehabilitation, in which patients and physicians agree upon concrete goals regarding the future health behaviour (healthy eating, physical activity, tobacco abstinence, medication adherence).


The target agreement concept was developed in two precursory studies, CARO-ZIR (Cardiac Rehabilitation Outcome – target agreements in rehabilitation; funded by the DRV Westfalen 2007/08) and CARO-QMS (Cardiac Rehabilitation Outcome – Quality Management Survey; funded by DRV Bund 2008/2009), applied to rehabilitation patients and physicians and checked in terms of their acceptance. It is deemed useful and helpful by both user groups.


The target agreement concept comprises:


The target agreements concern evidence-based risk factors, i.e. behavioural and physiological parameters with a demonstrable risk-influencing effect. Central to this concept, behavioural goals were purposely set for the behavioural factors of physical activity, healthy nutrition, tobacco abstinence and medication adherence, because patients can directly influence these behavioural goals. A second focus is on target values for the parameters of the physiological risk factors hyperlipidaemia, hypertension, diabetes mellitus and overweight/obesity.



The aim of the project is to examine the effectiveness of the target agreement concept with the following hypothesis: The target agreement concept leads, in male and female CHD patients, to an improved secondary preventive health behaviour in phase III rehabilitation.



The study design corresponds to a randomised controlled intervention study with three measurement time points. Inclusion criteria for the study were: acute coronary syndrome (ACS), bypass operation (ACB) or elective percutaneous coronary intervention (PCI).

The physicians participating in the study received training in advance on conducting dialogue and a manual developed for this purpose. The social-cognitive process model of health action (HAPA model [1]) of R. Schwarzer served as the theoretical basis.


Current status of the project

A total of 1389 rehabilitation patients from 17 establishments were included in the study. The proportion of female patients amounts to 38.4% (N=534) and of male patients 61.6% (N=855). 702 patients (50.5%) were included in the intervention group and 687 (49.5%) in the control group.

The response rate to the questionnaire survey at the individual measurement time points amounts to 94.4% (N=1311) at T1 (beginning of rehabilitation), 84.7% (N=1176) at T3 (six months after rehab), and 82.0% (N=1139) at T4 (twelve months after rehab). At the end of the rehabilitation, target agreement dialogues were conducted with 660 patients (404 male and 256 females). Currently, the evaluation of the collected process and questionnaire data is underway. First interim results will be available in the summer of 2012.


Conference/congress contributions


Cooperating rehabilitation establishments

At this point, we would like to thank all cooperating clinics for their good collaboration.



[1] HAPA stands for Health Action Process Approach and is a social-cognitive process model of health behaviour (Schwarzer, R.: 1992, 2001, 2002).

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