Harzand Arash, Weidman Aaron C, Rayl Kenneth R, Adesanya Adelanwa, Holmstrand Ericka, Fitzpatrick Nicole, Vathsangam Harshvardhan, Murali Srinivas
Emory University School of Medicine, Atlanta, GA, United States.
VITAL Innovation, Highmark Health, Pittsburgh, PA, United States.
Front Digit Health. 2021 Nov 24;3:678009. doi: 10.3389/fdgth.2021.678009. eCollection 2021.
Participation in cardiac rehabilitation (CR) is recommended for all patients with coronary artery disease (CAD) following hospitalization for acute coronary syndrome or stenting. Yet, few patients participate due to the inconvenience and high cost of attending a facility-based program, factors which have been magnified during the ongoing COVID pandemic. Based on a retrospective analysis of CR utilization and cost in a third-party payer environment, we forecasted the potential clinical and economic benefits of delivering a home-based, virtual CR program, with the goal of guiding future implementation efforts to expand CR access. We performed a retrospective cohort study using insurance claims data from a large, third-party payer in the state of Pennsylvania. Primary diagnostic and procedural codes were used to identify patients admitted for CAD between October 1, 2016, and September 30, 2018. Rates of enrollment in facility-based CR, as well as all-cause and cardiovascular hospital readmission and associated costs, were calculated during the 12-months following discharge. Only 37% of the 7,264 identified eligible insured patients enrolled in a facility-based CR program within 12 months, incurring a mean delivery cost of $2,922 per participating patient. The 12-month all-cause readmission rate among these patients was 24%, compared to 31% among patients who did not participate in CR. Furthermore, among those readmitted, CR patients were readmitted less frequently than non-CR patients within this time period. The average per-patient cost from hospital readmissions was $30,814 per annum. Based on these trends, we forecasted that adoption of virtual CR among patients who previously declined CR would result in an annual cost savings between $1 and $9 million in the third-party healthcare system from a combination of increased overall CR enrollment and fewer hospital readmissions among new HBCR participants. Among insured patients eligible for CR in a third-party payer environment, implementation of a home-based virtual CR program is forecasted to yield significant cost savings through a combination of increased CR participation and a consequent reduction in downstream healthcare utilization.
对于因急性冠状动脉综合征或支架置入术住院后的所有冠心病（CAD）患者，建议参与心脏康复（CR）。然而，由于参加基于机构的项目存在不便和成本高昂等因素，很少有患者参与，在持续的新冠疫情期间这些因素被进一步放大。基于对第三方支付环境下CR利用率和成本的回顾性分析，我们预测了开展居家虚拟CR项目的潜在临床和经济效益，目的是为未来扩大CR可及性的实施工作提供指导。我们使用宾夕法尼亚州一家大型第三方支付机构的保险理赔数据进行了一项回顾性队列研究。主要诊断和程序编码用于识别2016年10月1日至2018年9月30日期间因CAD入院的患者。在出院后的12个月内，计算基于机构的CR参与率、全因和心血管疾病再入院率及相关成本。在7264名确定符合条件的参保患者中，只有37%在12个月内参加了基于机构的CR项目，每位参与患者的平均实施成本为2922美元。这些患者的12个月全因再入院率为24%，未参加CR的患者为31%。此外，在再次入院的患者中，CR患者在此期间的再入院频率低于非CR患者。医院再入院的人均年均成本为30814美元。基于这些趋势，我们预测，让之前拒绝CR的患者采用虚拟CR，将使第三方医疗系统每年节省100万至900万美元的成本，这是由于总体CR参与率提高以及新的居家心脏康复（HBCR）参与者的医院再入院次数减少共同作用的结果。在第三方支付环境下符合CR条件的参保患者中，预计实施居家虚拟CR项目将通过增加CR参与率以及随之减少下游医疗利用，从而大幅节省成本。
