Gurewich Deborah, Prottas Jeffrey, Bhalotra Sarita, Suaya Jose A, Shepard Donald S
Brandeis University, Waltham, Massachusetts 02454, USA.
J Cardiopulm Rehabil Prev. 2008 Nov-Dec;28(6):380-5. doi: 10.1097/HCR.0b013e31818c3b5b.
Despite well-established benefits, only 10% to 20% of eligible candidates in the United States currently use formal cardiac rehabilitation (CR) services. Existing studies identify both patient- and provider-level barriers to physician referral and patient uptake. This study, which was driven by new evidence indicating that utilization rates vary enormously from state to state, within states, and from hospital to hospital, explores the relationship between system-level factors and CR use.
Using a qualitative design with semistructured questions, we telephone-interviewed both directors of CR facility programs and presidents of CR state associations operating in states with high and low rates of CR use. We explored the political and cultural environment in which CR facilities operate and the technical capacity to secure referrals and convert referrals to enrollment.
We identified 4 system-level factors that may help explain regional variation in CR use. These included the degree of automation and assertiveness around securing CR referrals, level of integration of CR within the hospital setting and physician community, relationship to other CR facilities, and capacity constraints.
As some of the identified system-level factors can be altered by public and hospital-level policy, study results suggest opportunities for interventions and directions for future research that could increase the use of CR.
尽管心脏康复（CR）已被证实具有诸多益处，但目前在美国，只有10%至20%符合条件的患者使用正规的心脏康复服务。现有研究确定了医生转诊和患者接受治疗方面患者及提供者层面的障碍。本研究受新证据推动，该证据表明利用率在州与州之间、州内以及医院之间差异极大，探讨了系统层面因素与心脏康复使用之间的关系。
采用带有半结构化问题的定性设计，我们对心脏康复设施项目主任以及心脏康复使用率高和低的州的心脏康复州协会主席进行了电话访谈。我们探讨了心脏康复设施运营所处的政治和文化环境，以及确保转诊并将转诊转化为登记的技术能力。
我们确定了4个可能有助于解释心脏康复使用区域差异的系统层面因素。这些因素包括在确保心脏康复转诊方面的自动化程度和坚定性、心脏康复在医院环境和医生群体中的整合程度、与其他心脏康复设施的关系以及能力限制。
由于已确定的一些系统层面因素可通过公共政策和医院层面政策加以改变，研究结果表明存在干预机会以及未来研究方向，有望增加心脏康复的使用。
