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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Joanne M. Matukaitis, RN, MSN, FAACVPR, Christiana Care Health System, Heart and Vascular Outreach, Eugene du Pont Preventive Medicine & Rehabilitation Institution, 3506 Kennett Pike, Room 254, Wilmington, DE 19807, 302-661-3432, jmatukaitis@christianacare.org
Objectives: At the conclusion of this session, the participant will be able to: (1) describe the impact of cardiovascular disease (CVD) on the public health; (2) list benefits of cardiac rehabilitation (CR) as tertiary prevention; and (3) learn effective methods to improve referral rates to CR.
CVD is the leading cause of disability and death in the US. In 1998, Medicare paid approximately $26.4 billion for CVD-related hospitalizations, averaging $8,000 per discharge. CR is tertiary prevention designed to reduce morbidity and mortality by improving exercise tolerance, quality of life and psychosocial well being, while at the same time controlling lipid levels, reducing stress, and eliminating tobacco use. Although CR participation saves an average of $5,000-$9,000 per patient in yearly healthcare costs, only 10-20% of eligible patients are referred. We identified a need to improve referral rates to our CR program, which averaged 17% for myocardial infarction (MI) patients.
The problems identified included: (1) we were only receiving referrals for approximately 17% of the MI population; (2) approximately 40% of patients referred refused CR; (3) the amount of time elapsed from inpatient discharge until initial contact to schedule the patient for CR was at times as long as four weeks; and (4) the two CR locations were using different processes for program entry.
We conducted a survey of patients in order to get a clearer picture of the reasons why CR was so underutilized. We developed a centralized processing system that reduced the time between inpatient discharge and initial contact for CR by consolidating patient scheduling, insurance authorization and billing at one site. In order to increase awareness of CR, our Medical Director provided monthly program updates to the Cardiology Team, including data on referral rates. We initiated two methods to obtain immediate physician referrals for outpatient CR prior to the patient’s discharge from the hospital.
After implementing these improvements, our annual referral rate rose to 57% for MI patients, far exceeding the initial goal of 40%. Our challenge is not only to continue to improve the rate of referrals, but also to increase the emphasis on primary and secondary prevention among physicians and patients in our system.
Learning Objectives: At the conclusion of this session, the participant will be able to
Keywords: Cardiorespiratory,
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.