Pack Quinn R, Squires Ray W, Lopez-Jimenez Francisco, Lichtman Steven W, Rodriguez-Escudero Juan P, Lindenauer Peter K, Thomas Randal J
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (Drs Pack, Squires, Lopez-Jimenez, Rodriguez-Escudero, and Thomas); Department of Cardiology (Dr Pack) and Department of Medicine (Dr Lindendauer), Baystate Medical Center, Springfield, Massachusetts; Tuft's University School of Medicine, Boston, Massachusetts (Drs Pack and Lindenauer); Department of Cardiology, Helen Hayes Hospital, West Haverstraw, New York (Dr Lichtman); and Department of Internal Medicine, Mount Sinai Medical Center, Miami, Florida (Dr Rodriguez-Escudero).
J Cardiopulm Rehabil Prev. 2015 May-Jun;35(3):173-80. doi: 10.1097/HCR.0000000000000108.
Although strategies exist for improving cardiac rehabilitation (CR) participation rates, it is unclear how frequently these strategies are used and what efforts are being made by CR programs to improve participation rates.
We surveyed all CR program directors in the American Association of Cardiovascular and Pulmonary Rehabilitation's database. Data collection included program characteristics, the use of specific referral and recruitment strategies, and self-reported program participation rates.
Between 2007 and 2012, 49% of programs measured referral of inpatients from the hospital, 21% measured outpatient referral from office/clinic, 71% measured program enrollment, and 74% measured program completion rates. Program-reported participation rates (interquartile range) were 68% (32-90) for hospital referral, 35% (15-60) for office/clinic referral, 70% (46-80) for enrollment, and 75% (62-82) for program completion. The majority of programs utilized a hospital-based systematic referral, liaison-facilitated referral, or inpatient CR program referral (64%, 68%, and 60% of the time, respectively). Early appointments (<2 weeks) were utilized by 35%, and consistent phone call appointment reminders were utilized by 50% of programs. Quality improvement (QI) projects were performed by about half of CR programs. Measurement of participation rates was highly correlated with performing QI projects (P < .0001.)
: Although programs are aware of participation rate gaps, the monitoring of participation rates is suboptimal, QI initiatives are infrequent, and proven strategies for increasing patient participation are inconsistently utilized. These issues likely contribute to the national CR participation gap and may prove to be useful targets for national QI initiatives.
尽管存在提高心脏康复（CR）参与率的策略，但尚不清楚这些策略的使用频率以及CR项目为提高参与率做出了哪些努力。
我们对美国心血管和肺康复协会数据库中的所有CR项目主任进行了调查。数据收集包括项目特征、特定转诊和招募策略的使用情况以及自我报告的项目参与率。
在2007年至2012年期间，49%的项目测量了医院住院患者的转诊情况，21%测量了办公室/诊所的门诊转诊情况，71%测量了项目登记情况，74%测量了项目完成率。项目报告的参与率（四分位间距）分别为：医院转诊68%（32 - 90），办公室/诊所转诊35%（15 - 60），登记70%（46 - 80），项目完成75%（62 - 82）。大多数项目采用基于医院的系统转诊、联络促进转诊或住院CR项目转诊（分别占64%、68%和60%的时间）。35%的项目采用了早期预约（<2周），50%的项目采用了持续的电话预约提醒。约一半的CR项目开展了质量改进（QI）项目。参与率的测量与开展QI项目高度相关（P < .0001）。
尽管项目意识到参与率存在差距，但对参与率的监测并不理想，QI举措很少，且提高患者参与度的成熟策略使用不一致。这些问题可能导致全国范围内的CR参与差距，并且可能被证明是全国QI举措的有用目标。
