Top Things to Know: Increasing Participation in Cardiac Rehabilitation
Published: January 30, 2012
- Outpatient cardiac rehabilitation (CR) dramatically reduces morbidity and mortality by nearly 25%, yet utilization is alarmingly low, particularly among those in rural areas, with lower socioeconomic status, limited education, and advanced age and/or female.
- Inpatient and home health care teams, specifically home-health nursing and physical therapy staff, can significantly improve CR referral and enrollment rates among eligible patients.
- Whether a patient is referred to a program while in the hospital and if the patient finds value in CR determines their participation in an outpatient program.
- A multidisciplinary team including nurses, clinical exercise physiologists (CEPs), physical therapists and registered dietitians should be involved in CR programs.
- A PT’s role in determining whether a patient can be discharged from the hospital gives ample opportunity to provide a referral to outpatient CR.
- Studies have shown confusion as to which member of the health care team is responsible for securing enrollment; this supports identifying a single member to be responsible for referral.
- Frequently, a time gap exists between acute care discharge and initiation of CR, resulting in a perception that CR is a choice and not an expectation for a complete recovery.
- To assess outpatient CR referral patterns, healthcare team members should be familiar with “AACVPR/ACCF/AHA 2010 update: Performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/ secondary prevention services” as well as the earlier version published in 2007.
- The inpatient CR director should maintain a strong relationship with the medical staff, have a defined level of autonomy, supervision over personnel, and initiate conversations with any referring physicians regarding preferences for outpatient centers and opinions on patient follow-up.
- Creating a CR referral system within inpatient and home health settings would allow greater knowledge about the program for both patients and providers.
Citation
Arena R, Williams M, Forman DE, et al. Increasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professional in the inpatient and home health settings. Circulation. Published online before print January 30, 2012, doi: 10.1161/CIR.0b013e318246b1e5.