CORRELATION BETWEEN INSURANCE COVERAGE AND AREA OF RESIDENCE, WITH ATTENDANCE TO A CARDIAC REHABILITATION PROGRAM IN THE UNITED ARAB EMIRATES

Background: There is a marked deficiency in attendance to CR both described in literature as well as observed in practice. A European review from 2018, EUROASPIRE IV identified that only 41% of patients referred to CR completed half of their sessions. In the United States of America poor geographical availability of programs and limited insurance coverage were noted as limiting factors to accessibility. Cleveland Clinic Abu Dhabi (CCAD) has ran the only CR program offered in the emirate since 2015, targeting a wide range of patients both in pathologies (post-surgical, myocardial infarct, heart failure, etc) and geographical locations.

Purpose: The objective of this project is to study the relationship between insurance and area of residence, with patient’s attendance to CCAD CR program.

Methods: Data was collected from the Electronic Medical Record for CR participants in CCAD for the period between January 2018 to December 2018. Regression modelling of completed encounters was done, using the following independent variables: Age, Gender, 6-Minute Walk Test, Insurance, Reason for Referral, Distance to hospital and Commute. Models followed Poisson, Negative Binomial and Zero-Inflated Negative Binomial distributions.

Results: The sample consisted of 289 individuals, 191 males and 98 females. Average age was 55.6 years (standard deviation of 14.5 years), minimum age of 16 and maximum of 92 years old. On average patients completed 5.62 encounters (standard deviation of 7.23 encounters), with 38.41% completing 5 or more encounters, and 25.95% completing 10 or more. No significance was observed for the coefficient for Insurance in any of the models tested. For both Distance and Commute significance of coefficients was observed. This indicates an association between residing more than 50km away from the hospital and attendance (less 8.8 encounters attended). Similarly having a commute of more than 30 minutes was also associated with reduced attendance (less 5.9 encounters).

Conclusion(s): Patients served by CCAD CR program didn’t complete the international recommended number of CR encounters in the year of 2018. Distance from residence to hospital was associated with attendance to CR, with patients living further away attending less. No relationship between insurance coverage and attendance was observed, although reduced referral rates for patients that are poorly insured might have impacted this analysis.

Implications: The CR program at CCAD is providing an important service previously unavailable in this region, with a significant impact on patient outcomes. This study provides preliminary data pointing towards an inverse relationship between distance and commute with attendance to CR. This study suggests the need of more equitable distribution of CR programs across the emirate of Abu Dhabi. The insights produced could support the development of satellite programs or development of telehealth practices as a way to promote attendance, as both could mitigate distance to facility. In addition, this methodology appears to be well geared to leverage the expanding use of Electronic Medical Records to deliver insightful information for the development of more effective Rehabilitation services.

Funding, acknowledgements: There was no funding necessary for the completion of this research. 

Keywords: Cardiac Rehabilitation, Accessibility, Attendance

Topic: Community based rehabilitation

Did this work require ethics approval? Yes

Institution: Cleveland Clinic Abu Dhabi

Committee: Research Ethics Committee

Ethics number: A-2019-046