Effect of Cardiac Rehabilitation Referral Strategies on Utilization Rates
Effect of Cardiac Rehabilitation Referral Strategies on Utilization Rates
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DOI：
10.1001/archinternmed.2010.501
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发表时间：
2011-02-14
影响因子：
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通讯作者：
Stewart, Donna E.
中科院分区：
文献类型：
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作者：
Grace, Sherry L.;Russell, Kelly L.;Stewart, Donna E.
背景：尽管心脏康复 (CR) 已被证明可以降低死亡率，并且是临床实践指南中推荐的组成部分，但 CR 转诊和利用率仍然很低。已经实施了推荐策略来增加 CR 使用，但尚未同时进行比较。为了确定最大化 CR 转诊、入组和参与的最佳策略，我们评估了 3 种转诊策略与常规护理的比较：仅通过出院单或电子记录的“自动”转诊策略、仅通过医疗保健提供者联络或综合方法。 方法：在这项前瞻性对照研究中，来自加拿大安大略省 11 家医院的 2635 名冠状动脉疾病住院患者使用 4 种转诊策略中的一种完成了社会人口学调查，并从医疗图表中提取了临床数据。一年后，1809 名参与者完成了一项评估 CR 利用率的邮寄调查。使用广义估计方程来比较转诊策略以控制医院的影响。结果：调整后的分析显示转诊策略与 CR 转诊和入组显着相关 (P < .001)。与常规转诊（32.2%）相比，自动转诊和联络转诊相结合的 CR 使用率最高（比值比 [OR]，8.41；转诊率 85.8%，入学率 73.5%），其次是仅自动转诊（OR，3.27；转诊率 70.2%，入学率 60.0%）和仅联络转诊（OR，3.35；转诊率 59.0%，入学率 50.6%）。推荐，29.0% 入学率）。 CR 参与程度并没有因转诊参与者的转诊策略而有所不同（平均 [SD] 参加课程的百分比，82.87% [27.20%]；P=.88）。 结论：自动转诊与患者讨论相结合可以实现报告的最高 CR 转诊率。更广泛地采用此类策略可以确保接受心脏病治疗的患者增加 45%，从而获得并实现 CR 的益处。
Background: Although cardiac rehabilitation (CR) has been shown to reduce mortality and is a recommended component in clinical practice guidelines, CR referral and utilization rates remain low. Referral strategies have been implemented to increase CR use but have yet to be compared concurrently. To determine the optimal strategy to maximize CR referral, enrollment, and participation, we evaluated 3 referral strategies compared with usual care: "automatic" only via discharge order or electronic record, health care provider liaison only, or a combined approach.Methods: In this prospective controlled study, 2635 inpatients with coronary artery disease from 11 Ontario, Canada, hospitals using 1 of the 4 referral strategies completed a sociodemographic survey, and clinical data were extracted from medical charts. One year later, 1809 participants completed a mailed survey that assessed CR utilization. Referral strategies were compared using generalized estimating equations to control for effect of hospital.Results: Adjusted analyses revealed referral strategy was significantly related to CR referral and enrollment (P < .001). Combined automatic and liaison referral resulted in the greatest CR use (odds ratio [OR], 8.41; 85.8% referral, 73.5% enrollment), followed by automatic only (OR, 3.27; 70.2% referral, 60.0% enrollment), and liaison only (OR, 3.35; 59.0% referral, 50.6% enrollment), compared with usual referral (32.2% referral, 29.0% enrollment). The degree of CR participation did not differ by referral strategy among referred participants (mean [SD] percentage of classes attended, 82.87% [27.20%]; P=.88).Conclusions: Automatic referral combined with a patient discussion can achieve among the highest rates of CR referral reported. Wider adoption of such strategies could ensure that 45% more patients being treated for cardiac disease would have access to and realize the benefits of CR.