Improving Cardiac Rehabilitation Attendance and Completion Through Quality Improvement Activities and a Motivational Program

Pack, Quinn R.; Johnson, Lezlie L.; Barr, Laurie; Daniels, Stephanie R.; Wolter, Anne D.; Squires, Ray W.; Perez‐Terzic, Carmen; Thomas, Randal J.

doi:10.1097/hcr.0b013e31828db386

Cited by 50 publications

(48 citation statements)

References 20 publications

(21 reference statements)

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“…44,45 If the appropriate barriers within these various groups are identified CR staff can determine what interventions may be most useful, whether it is more education for the patient on the benefits of CR, a more intensive smoking cessation program, being open outside of normal working hours one day a week, or offering incentives for program completion. 17,46 Smoking cessation interventions should be a particularly high priority given the strong associations between current smoking and both high morbidity and mortality combined with strong associations with poor CR attendance…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics Predictive of Cardiac Rehabilitation Adherence

Gaalema

Savage

Rengo

et al. 2017

Journal of Cardiopulmonary Rehabilitation and Prevention

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Purpose Cardiac rehabilitation (CR) is a program of structured exercise and interventions for coronary risk factor reduction that reduces morbidity and mortality following a major cardiac event. Although a dose response relationship between number of CR sessions completed and health outcomes has been demonstrated, adherence with CR is not high. In this study we examined associations between number ofsessions completed within CR and patient demographics, clinical characteristics, smoking status, and socioeconomic status (SES). Methods Multiple LogisticRegression and Classification and Regression Tree (CART) modeling were used to examine associations between participant characteristics measured at CR intake and number of sessions completed in a prospectively collected CR clinical database (N=1658). Results Current smoking, lower-SES, non-surgical diagnosis, exercise-limiting comorbidities, and lower age independently predicted fewer sessions completed. The CART analysis illustrates how combinations of these characteristics (i.e., risk profiles) predict number of sessions completed. Those with the highest-risk profile for non-adherence (less than 65 years old, current smoker, lower-SES) completed on average 9 sessions while those with the lowest-risk profile (greater than 72 years old, not current smoker, higher-SES, surgical diagnosis) completed on average 27 sessions. Conclusions Younger individuals, as well as those who report smoking, economic challenges, or have a non-surgical diagnosis, may require additional support to maintain CR session attendance.

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Section: Discussionmentioning

confidence: 99%

Patient Characteristics Predictive of Cardiac Rehabilitation Adherence

Gaalema

Savage

Rengo

et al. 2017

Journal of Cardiopulmonary Rehabilitation and Prevention

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“…Previous attempts at improving adherence in CR have been largely ineffective (Karmali et al, 2014); however, some success was garnered in a quality improvement project that included small, non-financial incentives (Pack et al, 2013). Improving CR participation in lower-SES patients is critical given their high risk factor burden (Albert et al, 2006; Alter et al, 2013; Govil et al, 2009) and poor participation rates (Suaya et al, 2007; Oberg et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Studies have discussed some potential legal considerations of implementing these programs into clinical care (e.g. Pack et al, 2013). Future studies should be conducted to test the efficacy and optimal parameters of incentivizing participation and adherence within CR as well as determine how to best implement a program into general practice.…”

Section: Discussionmentioning

confidence: 99%

Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients

Gaalema

Savage

Rengo

et al. 2016

Preventive Medicine

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Purpose Cardiac rehabilitation (CR) improves medical outcomes after myocardial infarction or coronary revascularization. Lower socioeconomic status (SES) patients are less likely to participate in and complete CR. The aim of this study was to test whether financial incentives may increase participation and adherence to CR among lower-SES patients. Methods Patients eligible to participate in CR with Medicaid insurance coverage were approached for inclusion. Patients were placed on an escalating incentive schedule of financial incentives contingent upon CR attendance. CR participation was compared to a usual care group of 101 Medicaid patients eligible for CR in the 18 months prior to the study. Attendance (participating in ≥ one CR sessions) and adherence (sessions completed out of 36) were compared between groups. Study conducted in Vermont, USA, 2013–2015. Results Of 13 patients approached to be in the study and receive incentives, 10 (77%) agreed to participate. All 10 patients completed at least one session of CR, significantly greater than the 25/101 (25%) in the control condition (p < 0.001). Of patients in both groups who attended at least one session of CR, adherence was higher in the intervention group (average of 31.1 sessions completed vs. 13.6 in the control group, p < 0.001). CR completion rates were also higher during the intervention with 8 of 10 (80%) intervention patients completing all 36 sessions compared to only 2 of 25 (8%) control patients (p < 0.001). Conclusions Financial incentives may be an efficacious strategy for increasing CR participation and adherence among Medicaid patients.

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“…Table 2 41,46–55 summarizes adherence strategies that have been studied to maximize adherence, such as an expectation that patients complete all 36 sessions of the CR protocol and small motivational rewards or incentives for completing blocks of sessions. 46,47 Contemporary CR programs are encouraged to incrementally adopt and apply many of these strategies, eventually incorporating them as routine elements of daily operations.…”

Section: Increasing Adherence To Crmentioning

confidence: 99%

“…46,47 Contemporary CR programs are encouraged to incrementally adopt and apply many of these strategies, eventually incorporating them as routine elements of daily operations. Other strategies to consider include record keeping by participants (eg, diaries, logs, step counts), matching program hours of operation to patient rather than to staff needs, and offering program content that is culturally and linguistically appropriate and considerate of age, sex, comorbidities, and coexisting disabilities.…”

Section: Increasing Adherence To Crmentioning

confidence: 99%

Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative

Ades

Keteyian

Wright

et al. 2017

Mayo Clinic Proceedings

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335

287

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The primary aim of the Million Hearts initiative is to prevent 1 million cardiovascular events over 5 years. Concordant with the Million Hearts’ focus on achieving more than 70% performance in the “ABCS” of aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation, we outline the cardiovascular events that would be prevented and a road map to achieve more than 70% participation in cardiac rehabilitation (CR)/secondary prevention programs by the year 2022. Cardiac rehabilitation is a class Ia recommendation of the American Heart Association and the American College of Cardiology after myocardial infarction or coronary revascularization, promotes the ABCS along with lifestyle counseling and exercise, and is associated with decreased total mortality, cardiac mortality, and rehospitalizations. However, current participation rates for CR in the United States generally range from only 20% to 30%. This road map focuses on interventions, such as electronic medical record–based prompts and staffing liaisons that increase referrals of appropriate patients to CR, increase enrollment of appropriate individuals into CR, and increase adherence to longer-term CR. We also calculate that increasing CR participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations annually in the United States.

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Improving Cardiac Rehabilitation Attendance and Completion Through Quality Improvement Activities and a Motivational Program

Cited by 50 publications

References 20 publications

Patient Characteristics Predictive of Cardiac Rehabilitation Adherence

Patient Characteristics Predictive of Cardiac Rehabilitation Adherence

Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients

Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative

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