Departments of Medicine and Health Policy (Dr Bachmann), Department of Physical Medicine and Rehabilitation (Messrs Jagoda and McNatt, and Ms Abney), Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Dr Frontera), Department of Biostatistics (Dr Huang), and Department of Medicine (Drs Liddle and Freiberg), Vanderbilt University Medical Center, Nashville, Tennessee; and Healthways, Inc, Franklin, Tennessee (Mr Klint).
J Cardiopulm Rehabil Prev. 2017 Sep;37(5):322-328. doi: 10.1097/HCR.0000000000000255.
Wait times for the first cardiac rehabilitation (CR) session are inversely related to CR participation rates. We hypothesized that changing from individually scheduled appointments to a group enrollment and open gym format, in which patients were enrolled during group intake sessions and could arrive for subsequent CR sessions any time during open gym periods, would decrease wait times.
A total of 603 patients enrolled in CR at Vanderbilt University Medical Center from July 2012 to December 2014 were included in the study. We evaluated the effect of changing to a group enrollment and open gym format after adjusting for referral diagnosis, insurance status, seasonality, and other factors. We compared outcomes, including exercise capacity and quality of life, between the 2 groups.
Patients in the group enrollment and open gym format had significantly lower average wait times than those receiving individual appointments (14.9 vs 19.5 days, P < .001). After multivariable adjustment, the new CR delivery model was associated with a 22% (3.7 days) decrease in average wait times (95% CI, 1.9-5.6, P < .001). Patients completing CR had equally beneficial changes in 6-minute walk distance and Patient Health Questionnaire scores between the 2 groups, although there was no significant difference in participation rates or the number of sessions attended.
Implementation of a group enrollment and open gym format was associated with a significant decrease in wait times for first CR sessions. This CR delivery model may be an option for programs seeking to decrease wait times.
首次心脏康复（CR）治疗的等待时间与 CR 参与率呈反比。我们假设，将预约时间从个人预约改为团体注册和开放健身房模式，即患者在团体就诊期间注册，并可在开放健身房期间的任何时间参加随后的 CR 治疗，将缩短等待时间。
共有 603 名患者于 2012 年 7 月至 2014 年 12 月在范德比尔特大学医学中心参加了 CR 研究。我们评估了在调整转诊诊断、保险状况、季节性和其他因素后，改为团体注册和开放健身房模式的效果。我们比较了两组的结局，包括运动能力和生活质量。
与接受个人预约的患者相比，团体注册和开放健身房模式的患者平均等待时间明显缩短（14.9 天比 19.5 天，P<0.001）。经过多变量调整后，新的 CR 治疗模式与平均等待时间缩短 22%（3.7 天）相关（95%CI，1.9-5.6，P<0.001）。在两组患者中，完成 CR 的患者在 6 分钟步行距离和患者健康问卷评分方面都有同样有益的变化，尽管参与率或参加的治疗次数没有显著差异。
实施团体注册和开放健身房模式与首次 CR 治疗的等待时间显著缩短相关。这种 CR 治疗模式可能是寻求缩短等待时间的项目的一个选择。
