Wang Maggie, Torosyan Nare, Bairey-Merz C Noel, Wei Janet, Shufelt Chrisandra L
Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
Am J Prev Cardiol. 2022 May 10;10:100349. doi: 10.1016/j.ajpc.2022.100349. eCollection 2022 Jun.
Referrals to cardiac rehabilitation (CR) remain low despite evidence showing reduction in cardiovascular mortality and hospital readmissions. Resident education and awareness may be an opportunity to address barriers to CR referrals.
This pilot study involves 20 internal medicine residents rotating at an ambulatory primary care clinic. Voluntary surveys were sent through an online-based survey platform. Following survey completion, residents received a 10-minute scripted lecture and an educational handout outlining CR components, availability, indications, insurance eligibility criteria, and referral process. Surveys were redistributed 2 months post-education to assess changes in mean aggregate knowledge scores and attitude ratings on a 5-point Likert scale. CR referral rates of eligible patients pre- and post-education were obtained through review of electronic medical records.
Sixteen (80%) residents completed both pre and post surveys, and 13 (81%) reported no education on CR in the prior year. There was a significant increase in mean aggregate knowledge scores on CR components (5.1 versus 7.0, = 0.001), insurance coverage (2.4 versus 5.6, < 0.001), and eligible diagnoses (7.1 versus 9.9, = 0.03) following education. Attitudes towards CR also improved following education, particularly in self-reported comfort level with explaining CR to patients (3.69 versus 2.06, <0.001) and perceived familiarity with CR referral process (4.00 versus 2.18, <0.001). CR referrals increased from 0% (0 out of 10 eligible patients) to 33% (3 out of 9 eligible patients) over a 2-month period before and after education, respectively ( = 0.09).
Internal medicine resident knowledge and attitudes towards CR significantly improved after formal education. Although there was a modest increase in the rates of CR referrals following resident education, this pilot study was not powered to detect statistical significance.
尽管有证据表明心脏康复（CR）可降低心血管疾病死亡率和住院再入院率，但转介至心脏康复的患者数量仍然很少。住院医师教育和认知可能是解决心脏康复转介障碍的一个契机。
这项试点研究纳入了20名在门诊基层医疗诊所轮转的内科住院医师。通过在线调查平台发送自愿调查问卷。调查完成后，住院医师接受了一场10分钟的脚本讲座，并收到一份教育手册，其中概述了心脏康复的组成部分、可及性、适应症、保险资格标准和转介流程。教育结束2个月后重新发放调查问卷，以评估平均综合知识得分的变化以及在5分李克特量表上的态度评分。通过查阅电子病历获得教育前后符合条件患者的心脏康复转介率。
16名（80%）住院医师完成了教育前后的调查，13名（81%）报告称上一年没有接受过心脏康复方面的教育。教育后，关于心脏康复组成部分的平均综合知识得分（5.1对7.0，P = 0.001）、保险覆盖范围（2.4对5.6，P < 0.001）和符合条件的诊断（7.1对9.9，P = 0.03）均显著提高。教育后对心脏康复的态度也有所改善，尤其是在自我报告向患者解释心脏康复的舒适度方面（3.69对2.06，P < 0.001）以及对心脏康复转介流程的熟悉程度方面（4.00对2.18，P < 0.001）。在教育前后的2个月内，心脏康复转介率分别从0%（10名符合条件的患者中0人）增至33%（9名符合条件的患者中3人）（P = 0.09）。
经过正规教育后，内科住院医师对心脏康复的知识和态度有显著改善。尽管住院医师教育后心脏康复转介率有适度提高，但这项试点研究的样本量不足以检测到统计学显著性。
