Hospital and Operator Variation in Cardiac Rehabilitation Referral and Participation After Percutaneous Coronary Intervention: Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium
Hospital and Operator Variation in Cardiac Rehabilitation Referral and Participation After Percutaneous Coronary Intervention: Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium
复制标题
DOI：
10.1161/circoutcomes.121.008242
复制
发表时间：
2021-11-01
影响因子：
6.9
通讯作者：
Gurm, Hitinder S.
中科院分区：
文献类型：
--
作者：
Sukul, Devraj;Seth, Milan;Gurm, Hitinder S.
背景：尽管其已确立的益处和国际指南的强烈支持，心脏康复（CR）的使用仍然很低。确定CR转诊和使用的决定因素可能有助于制定有针对性的政策和质量改进工作。我们评估了经皮冠状动脉介入治疗（PCI）医院和operators.METHODS之间CR转诊和使用的变化：我们对2012年1月1日至2018年3月31日期间在48家非联邦密歇根医院接受PCI的所有患者进行了回顾性观察性队列研究，这些患者的PCI临床注册记录与行政索赔数据相关联。主要结局包括院内CR转诊和CR参与，定义为出院后90天内至少一次门诊CR访视。贝叶斯分层回归模型进行拟合，以评估PCI医院和操作者之间的关联与CR转诊和使用后，调整患者的characteristics.RESULTS：在54 217例接受PCI，76.3%的患者接受了在医院转诊CR，27.1%参加CR出院后90天内。在院内CR转诊中，医院和操作者水平存在显著差异，中位比值比为3.88（95%可信区间[CI]，3.06-5.42）和1.64（95% CI，1.55-1.75），CR参与的中位比值比分别为1.83（95% CI，1.63-2.15）和1.40（95% CI，1.35-1.47）。院内CR转诊与CR参与的可能性增加显著相关（校正比值比，1.75 [95%CI，1.52-2.01]），并且这种相关性因治疗PCI的医院而异（比值比范围，0.92-3.75）和操作员结论：院内CR转诊和PCI术后90天CR使用因医院和操作者而异。院内CR转诊与下游CR使用的关联在不同医院之间也存在差异，而在不同运营商之间差异较小，这表明特定医院和运营商可能会更有效地将CR转诊转化为下游使用。了解解释这种差异的因素对于制定战略以全面提高公司责任参与率至关重要。
BACKGROUND: Despite its established benefit and strong endorsement in international guidelines, cardiac rehabilitation (CR) use remains low. Identifying determinants of CR referral and use may help develop targeted policies and quality improvement efforts. We evaluated the variation in CR referral and use across percutaneous coronary intervention (PCI) hospitals and operators.METHODS: We performed a retrospective observational cohort study of all patients who underwent PCI at 48 nonfederal Michigan hospitals between January 1, 2012 and March 31, 2018 and who had their PCI clinical registry record linked to administrative claims data. The primary outcomes included in-hospital CR referral and CR participation, defined as at least one outpatient CR visit within 90 days of discharge. Bayesian hierarchical regression models were fit to evaluate the association between PCI hospital and operator with CR referral and use after adjusting for patient characteristics.RESULTS: Among 54 217 patients who underwent PCI, 76.3% received an in-hospital referral for CR, and 27.1% attended CR within 90 days after discharge. There was significant hospital and operator level variation in in-hospital CR referral with median odds ratios of 3.88 (95% credible interval [CI], 3.06-5.42) and 1.64 (95% CI, 1.55-1.75), respectively, and in CR participation with median odds ratios of 1.83 (95% CI, 1.63-2.15) and 1.40 (95% CI, 1.35-1.47), respectively. In-hospital CR referral was significantly associated with an increased likelihood of CR participation (adjusted odds ratio, 1.75 [95% CI, 1.52-2.01]), and this association varied by treating PCI hospital (odds ratio range, 0.92-3.75) and operator (odds ratio range, 1.26-2.82).CONCLUSIONS: In-hospital CR referral and 90-day CR use after PCI varied significantly by hospital and operator. The association of in-hospital CR referral with downstream CR use also varied across hospitals and less so across operators suggesting that specific hospitals and operators may more effectively translate CR referrals into downstream use. Understanding the factors that explain this variation will be critical to developing strategies to improve CR participation overall.