Health system boosts cardiac rehab rates, improves patient care, with new referral process

Cardiac rehabilitation (CR) has been shown to reduce mortality, morbidity and readmissions among patients with ischemic heart disease, but it remains widely underused throughout the United States.

A key reason for this troubling trend, according to one group of researchers, is that the CR referral process is in need of a significant overhaul. The team put its theory to the test, implementing a redesigned process at a large hospital in Philadelphia, and shared the results in JAMA Network Open.

The group’s implanted changes involved developing an “opt-out CR referral decision pathway that used the EHR to automatically identify eligible patients.” Providers would be contacted when a patient was identified, and cardiologists were able to sign CR orders before the patient was sent home. Educational material focused on “the importance and relevance of CR therapy” was also provided to each patient.

The initial intervention began in 2017, and data from more than 2,800 patients was used for the team’s analysis.

Overall, the percentage of CR referrals at the intervention site was 85.7%. For the system’s other hospitals, where no intervention occurred, the percentage was 31.6%.

“Referral for cardiac rehab has traditionally been a manual process that involved many stakeholders,” senior author Mitesh Patel, MD, director of the Penn Medicine Nudge Unit at the University of Pennsylvania, said in a statement. “By restructuring the pathway as an opt-out decision, we were able to leverage technology to automate the process and significantly reduce the burden on clinicians and patients.”

“When we surveyed our providers prior to launching the intervention, we learned they were largely interested in having their patients participate in a cardiac rehab program after discharge, but they were not properly equipped to make that happen,” added co-author Elizabeth Jolly, RN, BSN, MBA, an interventional cardiology transitions coordinator at the Hospital of the University of Pennsylvania. “With our interventions, we saw that the opt-out pathway coupled with the list of facilities made the referral process effortless.”

One key advantage of the team’s intervention is that it is straightforward and easy to replicate at other care sites. Also, Patel observed, it was cost-effective and took advantage of existing platforms.

“This pathway represents a low-cost, scalable approach that could be expanded to other health systems and for other therapies,” the authors concluded.

The full study can be read here.

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