Improving Referral and Enrolment in Cardiac Rehabilitation: Findings from a Survey of American Association of Cardiopulmonary Rehabilitation (AACVPR) members

Cardiac rehabilitation (CR) is an under-utilized intervention with proven clinical efficacy. Although Medicare has covered outpatient CR since 1982, less than 20% of eligible Medicare beneficiaries utilized CR, with an eight-fold variation between high and low utilizing states. This study assessed the organizational, systemic, and provider attributes associated with referral and enrolment processes. A purposeful sample of AACVPR members was surveyed at their annual meeting in October, 2007. Quantitative analysis was performed using SAS and qualitative data were coded for themes. Preliminary findings from this study (n=337) indicate variation in the presence of systems for referral and enrolment among organizations. Cardiologists and cardiac surgeons emerged as powerful influences on CR referrals. Support from senior administrators was also perceived as a substantial factor in improving CR referral and enrolment. The impact of financial incentives and public reporting were mixed. Further quantitative analysis will model the impact of organizational type and size. Despite the great need for CR, barriers to its utilization exist at many points of the referral, enrolment, retention, and completion continuum. Identifying organizational and systemic factors affecting referral and enrolment into CR is a first step to addressing under-utilization. Best practices that are generalizable across organizations can improve uptake of CR. These are not limited to technical solutions, but also involve a shift in culture among providers, and political support of key stakeholders. Policymakers, payers and providers should find ways to identify and disseminate organizational and systemic features that enhance referral and enrolment into CR and lifestyle programs