enhancing referrals, enrollment and outcomes in cardiac rehabilitation the duke experience william...
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![Page 1: Enhancing Referrals, Enrollment and Outcomes in Cardiac Rehabilitation The Duke Experience William E. Kraus, MD The Duke Cardiac Rehabilitation Team NC](https://reader035.vdocuments.us/reader035/viewer/2022070411/56649cff5503460f949d128c/html5/thumbnails/1.jpg)
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
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State of the Art
Opportunity Provided by Readmissions
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Recent News
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Referrals
Automatic CPOE-based
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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.
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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
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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
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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
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Referral to CR is only half the problem Enrollment and Completion of the CR program is the real goal
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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
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Enrollment
Overcoming Patient Barriers
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October 2009-March 2010 average monthly CR-eligible patients at Duke
Series10
10
20
30
40
50
60
70
80
90
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
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Barriers to better enrollment
Kelechi Ndubuizu, DMS3
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Enhancing Outcomes
Tracking
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Outcomes in a CR Program
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Summary Evidence for Benefits of CR
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Summary Evidence for Benefits of CR