Who utilizes post-cardiac event rehabilitative services: Comparative statistics from Medicare's Lifestyle Modification Program Demonstration (LMPD)

The LMPD survey collected extensive demographic and clinical data regarding health, clinical status, family history, lifestyle (including diet and exercise) and supportive services on 470 LMPD participants and 652 matched controls. It was directed to participants at baseline, Years One and Two and to controls at Years One and Two. Two groups of matched controls (those who did and did not participate in cardiac rehabilitation [CR]) were identified through a clinical algorithm from Medicare claims. We compare the three groups and changes within each group. Results were also compared with statistics on the overall Medicare population. The three groups matched well on claims-based attributes, but significant differences were found in lifestyle choices, socio-economic characteristics, race/ethnicity, gender, and other demographic and clinical attributes. For example, from Year One interviews, lifestyle participants were most likely to be never smokers (44.3%), CR controls intermediate (35.2%), and non-CR controls least (31.8%) (p=0.003). Lifestyle participants reported making lifestyle changes on 5.43+ 0.10 dimensions over the past year, compared to 4.15 + 0.13 dimensions among CR controls and only 3.27 +0.15 dimensions among non-CR controls (p<0.000). Lifestyle programs are associated with favorable behavior changes among those who participate, but currently enroll only the most committed patients. Utilization of an existing Medicare benefit of proven efficacy, CR, is likewise very low. These survey data can help policy-makers formulate policies to influence delivery system and practice options for enhancing referrals, encouraging recruitment, and promoting retention in lifestyle and self-management programs.