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J Cardiopulm Rehabil Prev. 2015 May-Jun;35(3):173-80. doi: 10.1097/HCR.0000000000000108.

Participation Rates, Process Monitoring, and Quality Improvement Among Cardiac Rehabilitation Programs in the United States: A NATIONAL SURVEY.

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Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (Drs Pack, Squires, Lopez-Jimenez, Rodriguez-Escudero, and Thomas); Department of Cardiology (Dr Pack) and Department of Medicine (Dr Lindendauer), Baystate Medical Center, Springfield, Massachusetts; Tuft's University School of Medicine, Boston, Massachusetts (Drs Pack and Lindenauer); Department of Cardiology, Helen Hayes Hospital, West Haverstraw, New York (Dr Lichtman); and Department of Internal Medicine, Mount Sinai Medical Center, Miami, Florida (Dr Rodriguez-Escudero).



Although strategies exist for improving cardiac rehabilitation (CR) participation rates, it is unclear how frequently these strategies are used and what efforts are being made by CR programs to improve participation rates.


We surveyed all CR program directors in the American Association of Cardiovascular and Pulmonary Rehabilitation's database. Data collection included program characteristics, the use of specific referral and recruitment strategies, and self-reported program participation rates.


Between 2007 and 2012, 49% of programs measured referral of inpatients from the hospital, 21% measured outpatient referral from office/clinic, 71% measured program enrollment, and 74% measured program completion rates. Program-reported participation rates (interquartile range) were 68% (32-90) for hospital referral, 35% (15-60) for office/clinic referral, 70% (46-80) for enrollment, and 75% (62-82) for program completion. The majority of programs utilized a hospital-based systematic referral, liaison-facilitated referral, or inpatient CR program referral (64%, 68%, and 60% of the time, respectively). Early appointments (<2 weeks) were utilized by 35%, and consistent phone call appointment reminders were utilized by 50% of programs. Quality improvement (QI) projects were performed by about half of CR programs. Measurement of participation rates was highly correlated with performing QI projects (P < .0001.)


: Although programs are aware of participation rate gaps, the monitoring of participation rates is suboptimal, QI initiatives are infrequent, and proven strategies for increasing patient participation are inconsistently utilized. These issues likely contribute to the national CR participation gap and may prove to be useful targets for national QI initiatives.

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