Brual Janette, Gravely Shannon, Suskin Neville, Stewart Donna E, Grace Sherry L
Department of Geography, Queen's University, Kingston, Canada.
Int J Rehabil Res. 2012 Sep;35(3):220-6. doi: 10.1097/MRR.0b013e328353e375.
Cardiac rehabilitation (CR) is most often provided in a hospital setting. Home-based models of care have been developed to overcome geographic, among other, barriers in patients at a lower risk. This study assessed whether clinical and geographic factors were related to the use of either a hospital-based or a home-based program. Secondary analysis was undertaken within a study of 1268 cardiac outpatients recruited from 97 cardiologist practices where clinical data were extracted. Participants completed a survey including the Duke Activity Status Index. They reported CR utilization in a second survey mailed 9 months later, including CR site and program model. Geographic information systems were used to determine the distances and the drive times to the CR site attended from patients' homes. Overall, 469 (37.0%) participants attended CR at one of 41 programs. Of the 373 (79.5%) participants with complete geographic data, 43 (11.5%) reported attending home-based CR. The sole clinical difference was in activity status, where patients attending a hospital-based program had lower activity status (P<0.01). There were no differences in model attended on the basis of geographic parameters including urban versus rural dwelling or drive times (P>0.05). In conclusion, only one-tenth of outpatients participated in a home-based program, and this allocation was unrelated to geographic considerations. Although patients should continue to be appropriately triaged on the basis of clinical risk to ensure safety, more targeted allocation of patients to home-based services may be warranted. This may optimize the degree of participation and potentially patient outcomes.
心脏康复（CR）通常在医院环境中提供。为克服地理及其他障碍，已开发出针对低风险患者的居家护理模式。本研究评估了临床和地理因素是否与基于医院或基于家庭的项目使用情况相关。在一项对从97个心脏病专家诊所招募的1268名心脏门诊患者的研究中进行了二次分析，从中提取临床数据。参与者完成了一项包括杜克活动状态指数的调查。他们在9个月后邮寄的第二项调查中报告了CR的使用情况，包括CR地点和项目模式。利用地理信息系统确定从患者家中到所参加的CR地点的距离和驾车时间。总体而言，469名（37.0%）参与者在41个项目之一接受了CR。在有完整地理数据的373名（79.5%）参与者中，43名（11.5%）报告参加了居家CR。唯一的临床差异在于活动状态，参加基于医院项目的患者活动状态较低（P<0.01）。基于包括城乡居住或驾车时间在内的地理参数，所参加的模式没有差异（P>0.05）。总之，只有十分之一的门诊患者参加了居家项目，这种分配与地理因素无关。尽管应继续根据临床风险对患者进行适当分类以确保安全，但可能有必要更有针对性地将患者分配到居家服务。这可能会优化参与程度并潜在改善患者结局。
