Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative.
Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative.
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跟踪医疗保险受益人之间的心脏康复参与和完成，以告知国家倡议的努力。
DOI：
10.1161/circoutcomes.119.005902
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发表时间：
2020-01
期刊：
影响因子：
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通讯作者：
Wright J
中科院分区：
文献类型：
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作者：
Ritchey MD;Maresh S;McNeely J;Shaffer T;Jackson SL;Keteyian SJ;Brawner CA;Whooley MA;Chang T;Stolp H;Schieb L;Wright J
尽管心脏康复（CR）被证明可以改善心脏病患者的健康结果，但其使用并不理想。作为回应，百万心脏康复合作组织制定了改善CR使用的路线图，包括到2022年将参与率提高到≥70%。这项观察性研究提供了衡量进展的当前估计，并确定了CR服务利用不足风险最大的人群和地区。我们确定了2016年符合CR条件的医疗保险服务收费受益人，并评估了到2017年CR参与情况（≥1次CR参加）、及时启动（事件发生后21天内参加）和完成情况（≥36次CR参加）。通过受益人特征和地理位置以及主要符合cr条件的事件类型（急性心肌梗死住院、冠状动脉搭桥手术、心脏瓣膜修复/置换术、经皮冠状动脉介入治疗或心脏/心肺移植）对措施进行了总体评估。在366 103名符合CR资格的受益人中，89 327人（24.4%）参加了CR，其中24.3%的人在21天内开始，26.9%的人完成了CR。资格最高的是东中南人口普查区（14.8 / 1000）。随着年龄的增长，参与率下降，女性（18.9%）低于男性（28.6%；调整患病率：0.91 [95% CI, 0.90-0.93]），西班牙裔（13.2%）和非西班牙裔黑人（13.6%）低于非西班牙裔白人(25.8%；调整后的患病率分别为0.63[0.61-0.66]和0.70[0.67-0.72])，并因医院转诊地区和普查分区（范围：18.6%[东南中部]至39.1%[西北中部]）和符合条件的事件类型（范围：7.1%[未经手术的急性心肌梗死]至55.3%[仅行冠状动脉搭桥手术]）而异。及时启动因地理位置和资格赛类型而异；竣工情况因地理位置而异。只有四分之一的符合CR条件的医疗保险受益人参加了CR，并且观察到明显的差异。加强现有的有效战略和制定新的战略对于解决已注意到的差距和实现70%的参与率目标至关重要。
Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization. We identified Medicare fee-for-service beneficiaries who were CR eligible in 2016, and assessed CR participation (≥1 CR session attended), timely initiation (participation within 21 days of event), and completion (≥36 sessions attended) through 2017. Measures were assessed overall, by beneficiary characteristics and geography, and by primary CR-qualifying event type (acute myocardial infarction hospitalization; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant). Among 366 103 CR-eligible beneficiaries, 89 327 (24.4%) participated in CR, of whom 24.3% initiated within 21 days and 26.9% completed CR. Eligibility was highest in the East South Central Census Division (14.8 per 1000). Participation decreased with increasing age, was lower among women (18.9%) compared with men (28.6%; adjusted prevalence ratio: 0.91 [95% CI, 0.90–0.93]) was lower among Hispanics (13.2%) and non-Hispanic blacks (13.6%) compared with non-Hispanic whites (25.8%; adjusted prevalence ratio: 0.63 [0.61–0.66] and 0.70 [0.67–0.72], respectively), and varied by hospital referral region and Census Division (range: 18.6% [East South Central] to 39.1% [West North Central]) and by qualifying event type (range: 7.1% [acute myocardial infarction without procedure] to 55.3% [coronary artery bypass surgery only]). Timely initiation varied by geography and qualifying event type; completion varied by geography. Only 1 in 4 CR-eligible Medicare beneficiaries participated in CR and marked disparities were observed. Reinforcement of current effective strategies and development of new strategies will be critical to address the noted disparities and achieve the 70% participation goal.