Drive time to cardiac rehabilitation: at what point does it affect utilization?
Drive time to cardiac rehabilitation: at what point does it affect utilization?
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DOI：
10.1186/1476-072x-9-27
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发表时间：
2010-06-04
影响因子：
4.9
通讯作者：
Grace, Sherry L.
中科院分区：
文献类型：
--
作者：
Brual, Janette;Gravely-Witte, Shannon;Grace, Sherry L.
背景：30分钟的驾车时间阈值经常被引用作为可获得保健服务的指示。心脏康复（CR）是一项慢性疾病管理计划，旨在增强和维持心血管健康，地理上的障碍经常被引用。本研究的目的是实证检验驾驶时间阈值对CR利用率的影响。方法：一项前瞻性研究，采用多层次设计的冠状动脉疾病门诊患者嵌套在97心脏病专家。参与者完成了基线社会人口调查，并在9个月后报告了CR转诊、登记和第二次调查的参与情况。利用CR站点验证了CR的利用率。地理信息系统用于生成从参与者家中到最近的CR站点的限速为60,80,100%的驾驶时间，以考虑各种交通状况。采用双变量分析检验驾车时间对CR转诊、入组和参与程度的差异。逻辑回归用于测试驱动时间增量，其中发现显着差异。结果：1209例门诊患者产生驱动次数。总体而言，523例（43.3%）门诊患者的CR转诊得到验证，444例（36.7%）经验证的登记参加了平均86.4 +/- 25.7%的规定疗程。驾车时间对CR转诊和入组有显著影响（p < 0.01），但对参与程度无显著影响。Logistic回归分析（ps < 0.001）显示，医生转诊达到限速80%的驾驶时间阈值可能为60分钟（OR = 0.26, 95% CI: 0.13-0.55）， CR入组患者的阈值也可能为60分钟（OR = 0.11, 95% CI: 0.04-0.33）。结论：医生在推荐患者进行CR时可能会考虑地理因素。实证研究还表明，如果患者必须开车60分钟或更长时间才能到达最近的项目，那么患者参加CR的可能性就会显著降低。一旦入学，距离对参与程度没有显著影响。
Background: A 30 minute drive time threshold has often been cited as indicative of accessible health services. Cardiac rehabilitation (CR) is a chronic disease management program designed to enhance and maintain cardiovascular health, and geographic barriers to utilization are often cited. The purpose of this study was to empirically test the drive time threshold for CR utilization.Methods: A prospective study, using a multi-level design of coronary artery disease outpatients nested within 97 cardiologists. Participants completed a baseline sociodemographic survey, and reported CR referral, enrollment and participation in a second survey 9 months later. CR utilization was verified with CR sites. Geographic information systems were used to generate drive times at 60, 80 and 100% of the speed limit to the closest CR site from participants' homes, to take into consideration various traffic conditions. Bivariate analysis was used to test for differences in CR referral, enrollment and degree of participation by drive time. Logistic regression was used to test drive time increments where significant differences were found.Results: Drive times were generated for 1209 outpatients. Overall, CR referral was verified for 523 (43.3%) outpatients, with verified enrollment for 444 (36.7%) participating in a mean of 86.4 +/- 25.7% of prescribed sessions. There were significant differences in CR referral and enrollment by drive time (ps < .01), but not degree of participation. Logistic regression analysis (ps < .001) revealed that the drive time threshold at 80% of the posted speed limit for physician referral may be 60 minutes (OR = .26, 95% CI: 0.13-0.55), and the threshold for patient CR enrollment may also be 60 minutes (OR = .11, 95% CI: 0.04-0.33).Conclusions: Physicians may be taking geography into consideration when referring patients to CR. Empirical consideration also reveals that patients are significantly less likely to enroll in CR where they must drive 60 minutes or more to the closest program. Once enrolled, distance has no significant effect on degree of participation.