Pollack Lisa M, Chang Anping, Thompson Michael P, Keteyian Steven J, Stolp Haley, Wall Hilary K, Sperling Laurence S, Jackson Sandra L
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am Heart J. 2025 Apr;282:58-69. doi: 10.1016/j.ahj.2024.12.004. Epub 2024 Dec 13.
To inform the delivery of cardiac rehabilitation (CR) care nationwide at the hospital level, we described hospital-level variation in CR metrics, overall and stratified by the hospital's tier of cardiac care provided.
This retrospective cohort analysis used Medicare fee-for-service (FFS) data (2018-2020), Parts A and B, and American Hospital Association (AHA) data (2018). We included beneficiaries with an acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) in 2018, aged ≥65 years, and continuously enrolled in a FFS plan. We calculated hospital-level metrics for hospitals with ≥20 CR-qualifying events, which were identified using diagnostic/procedure codes. Claims for CR were identified by Healthcare Common Procedure Coding System (HCPCS) codes. We used multi-level models to examine patient- and hospital-level factors associated with CR metrics. Hospitals were stratified by tier of cardiac care provided (comprehensive, AMI/PCI, AMI-only care).
Across the US, 2,212 hospitals treated individuals aged ≥65 years with a CR-qualifying event in 2018. By tier of cardiac care, 44.4% of hospitals provided comprehensive care, 31.2% provided AMI/PCI care, and 24.4% provided AMI-only care. Across all hospitals, there was substantial variation in CR enrollment (median 19.6%, interquartile range [IQR] = 7.0%, 32.8%). Among hospitals with enrollment (n = 1,866), median time to enrollment was 55.0 days (IQR = 41.0, 71.0), median number of CR sessions was 26.0 (IQR = 23.0, 29.0), and median percent completion was 26.0% (IQR = 10.5%, 41.2%). There was also substantial variation in CR performance metrics among hospitals within each tier of cardiac care (eg, median percent CR enrollment was 30.7% [IQR = 20.7%-41.3%] among comprehensive care hospitals, 18.6% [IQR = 9.5%-27.7%] among AMI/PCI hospitals, and 0.0% [IQR = 0.0%-7.7%] among AMI-only hospitals). In adjusted analyses, characteristics associated with lower odds of CR enrollment included patient-level factors (older age, female sex, non-White race or ethnicity), and hospital-level factors (for-profit ownership, regions other than the Midwest, rural location, medium/large hospital size).
This is the first national, hospital-level analysis of CR metrics among Medicare beneficiaries. Substantial variation across hospitals, including peer hospitals within the same tier of cardiac care, indicates opportunities for hospital-level quality improvement strategies to improve CR referral and participation metrics.
为了在医院层面为全国心脏康复（CR）护理的提供提供信息，我们描述了CR指标在医院层面的差异，总体情况以及按医院提供的心脏护理层级进行分层后的情况。
这项回顾性队列分析使用了医疗保险按服务付费（FFS）数据（2018 - 2020年），A部分和B部分，以及美国医院协会（AHA）数据（2018年）。我们纳入了2018年年龄≥65岁、患有急性心肌梗死（AMI）、经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）且持续参保FFS计划的受益人。我们为有≥20例符合CR条件事件的医院计算医院层面的指标，这些事件通过诊断/程序代码确定。CR的索赔通过医疗保健通用程序编码系统（HCPCS）代码识别。我们使用多层次模型来检查与CR指标相关的患者和医院层面的因素。医院按提供的心脏护理层级进行分层（综合、AMI/PCI、仅AMI护理）。
在美国，2018年有2212家医院治疗了年龄≥65岁且有符合CR条件事件的个体。按心脏护理层级划分，44.4%的医院提供综合护理，31.2%提供AMI/PCI护理，24.4%提供仅AMI护理。在所有医院中，CR登记情况存在很大差异（中位数为19.6%，四分位间距[IQR]=7.0%，32.8%）。在有登记的医院（n = 1866）中，登记的中位时间为55.0天（IQR = 41.0，71.0），CR疗程的中位数为26.0（IQR = 23.0，29.0），完成百分比的中位数为26.0%（IQR = 10.5%，41.2%）。在每个心脏护理层级内的医院之间，CR绩效指标也存在很大差异（例如，综合护理医院中CR登记的中位数百分比为30.7%[IQR = 20.7% - 41.3%]，AMI/PCI医院中为18.6%[IQR = 9.5% - 27.7%]，仅AMI医院中为0.0%[IQR = 0.
