Cardiac Rehabilitation and the COVID-19 Pandemic: Persistent Declines in Cardiac Rehabilitation Participation and Access Among US Medicare Beneficiaries.
Cardiac Rehabilitation and the COVID-19 Pandemic: Persistent Declines in Cardiac Rehabilitation Participation and Access Among US Medicare Beneficiaries.
复制标题
DOI：
10.1161/circoutcomes.122.009618
复制
发表时间：
2022-12
影响因子：
6.9
通讯作者：
Kazi, Dhruv S.
中科院分区：
文献类型：
--
作者：
Varghese, Merilyn S.;Beatty, Alexis L.;Song, Yang;Xu, Jiaman;Sperling, Laurence S.;Fonarow, Gregg C.;Keteyian, Steven J.;McConeghy, Kevin W.;Penko, Joanne;Yeh, Robert W.;Figueroa, Jose F.;Wu, Wen-Chih;Kazi, Dhruv S.
新冠肺炎大流行对参与和获得心脏康复(CR)的影响尚不清楚。在符合条件的Medicare按服务收费受益人中，我们按月评估了2019年1月至2021年12月期间每100,000名受益人参加CR会议的次数、有资格启动CR的个人以及提供面对面CR的中心。我们比较了两个时期的结果：2019年12月1日至2020年2月28日(时期1，宣布与大流行有关的国家紧急状态之前)和2021年10月1日至2021年12月31日(时期2，目前可获得数据的最新时期)。在第1期，医疗保险受益人每月参加(平均值±SD)每100,000名受益人895±84次CR会议。在宣布国家紧急状态后，2020年4月，CR参与率急剧下降至每10万名受益人中有56次CR会议。到2021年12月，CR参与率逐渐恢复，但仍低于大流行前的水平(第2期：每100,000名受益人每月参加CR会议698±29次，p=0.02)。CR参与率的下降在双重医疗保险和医疗补助参与者以及居住在农村地区或社会弱势社区的患者中最为明显。在这两个时期之间，CR资格没有统计上的显著变化。与周期1的2,618±5个CR中心相比，周期2的CR中心数为2,464±7个(p<；0.01)。与在大流行中幸存下来的CR中心相比，关闭的220个CR中心更有可能附属于位于农村地区的公立医院，并为最脆弱的社会社区提供服务。新冠肺炎大流行与CR参与率持续下降和CR中心关闭有关，这对农村和低收入患者以及社会上最脆弱的社区造成了不成比例的影响。迫切需要在CR融资和交付方面进行创新，以公平地提高联邦医疗保险受益人的CR参与率。
The impact of the COVID-19 pandemic on participation in and availability of cardiac rehabilitation (CR) is unknown. Among eligible Medicare fee-for-service beneficiaries, we evaluated, by month, the number of CR sessions attended per 100,000 beneficiaries, individuals eligible to initiate CR, and centers offering in-person CR between January 2019 and December 2021. We compared these outcomes between two periods: December 1, 2019 through February 28, 2020 (period 1, prior to declaration of the pandemic-related national emergency) and October 1, 2021 through December 31, 2021 (period 2, the latest period for which data are currently available). In period 1, Medicare beneficiaries participated in (mean ± SD) 895 ± 84 CR sessions per 100,000 beneficiaries each month. After the national emergency was declared, CR participation sharply declined to 56 CR sessions per 100,000 beneficiaries in April 2020. CR participation recovered gradually through December 2021, but remained lower than pre-pandemic levels (Period 2: 698 ± 29 CR sessions per month per 100,000 beneficiaries, p=.02). Declines in CR participation were most marked among dual Medicare and Medicaid enrollees, and patients residing in rural areas or socially vulnerable communities. There was no statistically significant change in CR eligibility between the two periods. Compared with 2,618 ± 5 CR centers in period 1, there were 2,464 ± 7 in period 2 (p<0.01). Compared with CR centers that survived the pandemic, 220 CR centers that closed were more likely to be affiliated with public hospitals, located in rural areas, and serve the most socially vulnerable communities. The COVID-19 pandemic was associated with a persistent decline in CR participation and the closure of CR centers, which disproportionately affected rural and low-income patients and the most socially vulnerable communities. Innovation in CR financing and delivery is urgently needed to equitably enhance CR participation among Medicare beneficiaries.
DOI：
10.1016/j.amjms.2021.09.005
发表时间：
2022-04
期刊：
The American journal of the medical sciences
影响因子：
--
作者：
Diamond JE;McIlvaine S;Korjian S;Cruden P;Dechen T;Piatkowski G;Kazi DS;Gavin M
通讯作者：
Gavin M