enhancing referrals, enrollment and outcomes in cardiac rehabilitation the duke experience william...

Enhancing Referrals, Enrollment and Outcomes in Cardiac Rehabilitation

The Duke Experience

William E. Kraus, MDThe Duke Cardiac Rehabilitation Team

NC Cardiopulmonary Rehabilitation Association SymposiumChapel Hill, NC2 March 2011

State of the Art

Opportunity Provided by Readmissions

Recent News

Referrals

Automatic CPOE-based

CPOE Prompt

• Cardiac rehab prompt field was added to CPOE in August 2008 at Duke

• This prompt was displayed as part of the cardiology admission order set.

• It displayed eligibility criteria for cardiac rehab and served as a reminder to place a referral for appropriate patients.

Analyses

• Data collected during the 5 months prior to institution of CPOE prompt were compared to data collected during the 5 months after institution of CPOE reminder– Number of referrals to cardiac rehab – Number of patients enrolled in

cardiac rehab

Results

• 1845 patients were discharged from Duke Hospital over the 10 months of the study who met CR eligibility.– 980 prior to CPOE prompt– 865 after CPOE prompt

Fixing Duke CR referrals by admission CPOE prompt

Patients Eligible for Cardiac Rehab 1-year after New Referral System (n = 2626)

Patients Eligible for Cardiac Rehab 1-year before New Referral System (n = 2584)

Patel et al. (in press)

Only 34% referred66% not

referred to cardiac rehab

90% referred to Cardiac

rehab

10% not referred

Referral to CR is only half the problem Enrollment and Completion of the CR program is the real goal

172/471 = only 36.5% of those referred then

enrolled

Referral to CR is only half the problem Enrollment and Completion of the CR program is the real goal

Enrollment

Overcoming Patient Barriers

October 2009-March 2010 average monthly CR-eligible patients at Duke

Series10

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30

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50

60

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100

Chart Title

Seen by CR D/C before seen Duke CR, referred Duke enrolled

Kelechi Ndubuizu, DMS3

Almost half the patients leave the hospital before a CR team member could see them

Barriers to better enrollment

Kelechi Ndubuizu, DMS3

Enhancing Outcomes

Tracking

Outcomes in a CR Program

Summary Evidence for Benefits of CR

Summary Evidence for Benefits of CR