Enhancing Referrals, Enrollment and Outcomes in Cardiac Rehabilitation The Duke Experience William E. Kraus, MD The Duke Cardiac Rehabilitation Team NC.
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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
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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
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