追踪医疗保险受益人的心脏康复参与情况和完成情况，为一项全国性倡议的工作提供信息。
Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative.
作者信息
Ritchey Matthew D, Maresh Sha, McNeely Jessica, Shaffer Thomas, Jackson Sandra L, Keteyian Steven J, Brawner Clinton A, Whooley Mary A, Chang Tiffany, Stolp Haley, Schieb Linda, Wright Janet
机构信息
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.D.R., S.L.J., T.C., H.S., L.S.).
Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD (S.M., J.M., T.S.).
出版信息
Circ Cardiovasc Qual Outcomes. 2020 Jan;13(1):e005902. doi: 10.1161/CIRCOUTCOMES.119.005902. Epub 2020 Jan 14.
BACKGROUND
Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization.
METHODS AND RESULTS
We identified Medicare fee-for-service beneficiaries who were CR eligible in 2016, and assessed CR participation (≥1 CR session attended), timely initiation (participation within 21 days of event), and completion (≥36 sessions attended) through 2017. Measures were assessed overall, by beneficiary characteristics and geography, and by primary CR-qualifying event type (acute myocardial infarction hospitalization; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant). Among 366 103 CR-eligible beneficiaries, 89 327 (24.4%) participated in CR, of whom 24.3% initiated within 21 days and 26.9% completed CR. Eligibility was highest in the East South Central Census Division (14.8 per 1000). Participation decreased with increasing age, was lower among women (18.9%) compared with men (28.6%; adjusted prevalence ratio: 0.91 [95% CI, 0.90-0.93]) was lower among Hispanics (13.2%) and non-Hispanic blacks (13.6%) compared with non-Hispanic whites (25.8%; adjusted prevalence ratio: 0.63 [0.61-0.66] and 0.70 [0.67-0.72], respectively), and varied by hospital referral region and Census Division (range: 18.6% [East South Central] to 39.1% [West North Central]) and by qualifying event type (range: 7.1% [acute myocardial infarction without procedure] to 55.3% [coronary artery bypass surgery only]). Timely initiation varied by geography and qualifying event type; completion varied by geography.
CONCLUSIONS
Only 1 in 4 CR-eligible Medicare beneficiaries participated in CR and marked disparities were observed. Reinforcement of current effective strategies and development of new strategies will be critical to address the noted disparities and achieve the 70% participation goal.
背景
尽管心脏康复（CR）已被证明可改善心脏病患者的健康状况，但其应用仍未达到最佳效果。作为回应，“百万心脏”心脏康复协作组织制定了一份改善心脏康复应用的路线图，包括到2022年将参与率提高到≥70%。这项观察性研究提供了当前的评估数据以衡量进展情况，并确定心脏康复服务利用不足风险最高的人群和地区。
方法与结果
我们确定了2016年符合心脏康复条件的医疗保险按服务收费受益人，并评估了截至2017年的心脏康复参与情况（参加≥1次心脏康复疗程）、及时启动情况（在事件发生后21天内参与）和完成情况（参加≥36次疗程）。对各项指标进行了总体评估，以及按受益人特征、地理位置和主要符合心脏康复条件的事件类型（急性心肌梗死住院；冠状动脉搭桥手术；心脏瓣膜修复/置换；经皮冠状动脉介入治疗；或心脏/心肺移植）进行评估。在366103名符合心脏康复条件的受益人中，89327人（24.4%）参与了心脏康复，其中24.3%在21天内启动，26.9%完成了心脏康复。符合条件率在东中南部人口普查区最高（每1000人中有14.8人）。参与率随年龄增长而下降，女性（18.9%）低于男性（28.6%；调整后的患病率比：0.91[95%CI，0.90-0.93]），西班牙裔（13.2%）和非西班牙裔黑人（13.6%）低于非西班牙裔白人（25.8%；调整后的患病率比分别为0.63[0.61-0.66]和0.70[0.67-0.72]），并且因医院转诊地区和人口普查区而异（范围：18.6%[东中南部]至39.1%[西北中部]），也因符合条件的事件类型而异（范围：7.1%[无手术的急性心肌梗死]至55.3%[仅冠状动脉搭桥手术]）。及时启动情况因地理位置和符合条件的事件类型而异；完成情况因地理位置而异。
结论
在符合心脏康复条件的医疗保险受益人中，只有四分之一参与了心脏康复，并且观察到了明显的差异。加强当前有效的策略并制定新策略对于解决所指出的差异并实现70%的参与目标至关重要。
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