Face-to-Face Nursing Promotion of Cardiac Rehabilitation

10.46409/sr.jaij7944 ◽

2021 ◽

Author(s):

◽

Maria Whitaker

Keyword(s):

Cardiac Rehabilitation ◽

Artery Bypass ◽

Bypass Graft ◽

Cost Effective ◽

Healthcare Team ◽

Enrollment Rate ◽

Face To Face ◽

Effective Strategies ◽

Practice Problem ◽

Clinically Significant

Practice Problem: The burden of cardiovascular disease is rising at global and national levels, and cardiac rehabilitation is recognized as one of the most beneficial and cost-effective strategies to manage it. One significant problem globally, nationally, and locally is the low numbers of eligible patients who enroll in cardiac rehabilitation. PICOT: In patients with isolated coronary artery bypass graft (CABG) (P), how does face-to-face nursing promotion of cardiac rehabilitation (I) compared to the patients who do not have face-to-face nursing promotion (C), affect the percentage of patients enrolling in cardiac rehabilitation after discharge (O) within 8 weeks (T)? Evidence: The evidence used to guide this project included the need for a healthcare organization to have a systematic process for cardiac rehabilitation enrollment, face-to-face nursing promotion, improvement of the healthcare team’s knowledge about cardiac rehabilitation, and identification of patient barriers that hinder cardiac rehabilitation enrollment. Intervention: A systematic approach for cardiac rehabilitation was developed using the interprofessional team. After the healthcare team received standardized education, nurses in various roles provided face-to-face promotion, the ARNPs endorsed cardiac rehabilitation, and the care managers addressed barriers. Outcome: The cardiac rehabilitation enrollment rate increased by 16% among all patients admitted with an isolated CABG on the pilot unit. Conclusion: Implementation of face-to-face nursing promotion, ARNP endorsement, and reducing barriers were clinically significant in increasing the cardiac rehabilitation enrollment rate.

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Association Between Increased Hospital Reimbursement for Cardiac Rehabilitation and Utilization of Cardiac Rehabilitation by Medicare Beneficiaries

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.120.006572 ◽

2021 ◽

Vol 14 (3) ◽

Author(s):

Dana R. Fletcher ◽

Gary K. Grunwald ◽

Catherine Battaglia ◽

P. Michael Ho ◽

Richard C. Lindrooth ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Time Window ◽

Artery Bypass ◽

Cost Effective ◽

Coronary Intervention ◽

Guideline Recommendation ◽

Annual Growth Rate ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Percentage Points

Background: Although cardiac rehabilitation (CR) is a Class I Guideline recommendation, and has been shown to be a cost-effective intervention after a cardiac event, it has been reimbursed at levels insufficient to cover hospital operating costs. In January 2011, Medicare increased payment for CR in hospital outpatient settings by ≈180%. We evaluated the association between this payment increase and participation in CR of eligible Medicare beneficiaries to better understand the relationship between reimbursement policy and CR utilization. Methods: From a 5% Medicare claims sample, we identified patients with acute myocardial infarction, coronary artery bypass surgery, percutaneous coronary intervention, or cardiac valve surgery between January 1, 2009 and September 30, 2012, alive 30 days after their event, with continuous enrollment in Medicare fee-for-service, Part A/B for 4 months. Trends and changes in CR participation were estimated using an interrupted time series approach with a hierarchical logistic model, hospital random intercepts, adjusted for patient, hospital, market, and seasonality factors. Estimates were expressed using average marginal effects on a percent scale. Results: Among 76 695 eligible patients, average annual CR participation was 19.5% overall. In the period before payment increase, adjusted annual participation grew by 1.1 percentage points (95% CI, 0.48–2.4). No immediate change occurred in CR participation when the new payment was implemented. In the period after payment increase, on average, 20% of patients participated in CR annually. The annual growth rate in CR participation slowed in the post-period by 1.3 percentage points (95% CI, −2.4 to −0.12) compared with the prior period. Results were somewhat sensitive to time window variations. Conclusions: The 2011 increase in Medicare reimbursement for CR was not associated with an increase in participation. Future studies should evaluate whether payment did not reach a threshold to incentivize hospitals or if hospitals were not sensitive to reimbursement changes.

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