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Open Access Research

Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study

Sherry L Grace12345*, Kelly L Angevaare2, Robert D Reid6, Paul Oh35, Sonia Anand7, Milan Gupta8, Stephanie Brister2, Donna E Stewart2 and and On behalf of the CRCARE Investigators

Author Affiliations

1 School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Canada

2 Toronto General Hospital, University Health Network, 200 Elizabeth St, Toronto, Canada

3 Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, Canada

4 Mackenzie Health, 10 Trench Street, Richmond Hill, Canada

5 Cardiac Program, Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Canada

6 Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Canada

7 Clinical Epidemiology and Biostatistics, McMaster University, 237 Barton St. E, Hamilton, Canada

8 William Osler Health Centre, 2100 Bovaird Drive East, Brampton, Canada

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Implementation Science 2012, 7:120  doi:10.1186/1748-5908-7-120

Published: 13 December 2012

Abstract

Background

Despite the evidence of benefit, cardiac rehabilitation (CR) remains highly underutilized. The present study examined the effect of two inpatient and one outpatient strategy on CR utilization: allied healthcare provider completion of referral (a policy that had been endorsed and approved by the cardiac program leadership in advance; PRE-APPROVED); CR intake appointment booked before hospital discharge (PRE-BOOKED); and early outpatient education provided at the CR program shortly after inpatient discharge (EARLY ED).

In this prospective observational study, 2,635 stable cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey, and clinical data were extracted from charts. One year later, participants were a mailed survey that assessed CR use. Participating inpatient units and CR programs to which patients were referred were coded to reflect whether each of the strategies was used (yes/no). The effect of each strategy on participants’ CR referral and enrollment was examined using generalized estimating equations.

Results

A total of 1,809 participants completed the post-test survey. Adjusted analyses revealed that the implementation of one of the inpatient strategies was significantly related to greater referral and enrollment (PRE-APPROVED: OR = 1.96, 95%CI = 1.26 to 3.05, and OR = 2.91, 95%CI = 2.20 to 3.85, respectively). EARLY ED also resulted in significantly greater enrollment (OR = 4.85, 95%CI = 2.96 to 7.95).

Conclusions

These readily-implementable strategies could significantly increase access to and enrollment in CR for the cardiac population. The impact of these strategies on wait times warrants exploration.

Keywords:
Cardiac rehabilitation; Patient care management; Cardiovascular diseases