SYSTEMATIC STRATEGIES FOR IMPROVING CARDIAC REHABILITATION REFERRAL FOR PATIENTS WITH PCI

¹Cleveland Clinic Abu Dhabi, Rehabilitation, Abu Dhabi, United Arab Emirates

Background: Cardiovascular diseases remain the leading cause of death worldwide, and cardiac rehabilitation (CR) is a strategy used in secondary prevention of future cardiac events. CR is recommended for patients who have undergone percutaneous coronary intervention (PCI), which is a commonly performed procedure at our local hospital in Abu Dhabi. Benefits of program completion include: improved exercise capacity, improved self-management and lifestyle modification, medication adherence, and reduced ED visits and hospital readmission. Despite this, the in-house physiotherapist-led CR program receives a low rate of patients after PCI.

Purpose: The aim of this project is to determine reasons for low referral rates to CR program among patients with PCI, and describe the strategies put in place to mitigate these factors.

Methods: Examination of institutional workflows was performed including: compliance with referral placement, awareness and referral patterns from cardiology teams in outpatient clinics and inpatient wards, workflow from referral to CR scheduling, and patient characteristics including insurance eligibility and financial burden. Based on findings, efforts to reduce the impact of these issues were implemented.

Results: From January to March 2021, there were 65 patients with PCI, of which 37 were eligible for CR referral based on clinical condition. 23 (62.2%) were referred to CR. Strategies were implemented starting in April to improve referral rates, including:
1) education to cardiology teams to improve awareness of important of referral from clinic and hospital services,
2) identify patients with qualifying medical diagnoses for CR referral,
3) understanding and optimizing referral for those covered by insurance and those covered under mandate,
4) empowering under-insured patients to understand their self-pay options,
5) facilitating patient-centered scheduling into CR program including priority for patients coming from distant locations.
From April to May, 2021, 49 patients underwent PCI, 18 of which were eligible for CR based on clinical condition. 14 (77.8%) were referred to CR. One barrier to referral to CR was found to be lack of insurance coverage for the service.

Conclusions: In the first quarter of 2021, the referral rate to CR for patients with PCI was below the 50^th percentile of the aggregated data from the American College of Cardiology – National Cardiology Data Registry. After identifying gaps in workflows, interventions were carried out which resulted in a significant increase in the referral rates to CR. Patients without insurance coverage for CR are eligible for one follow-up clinic visit with cardiologist, however, there is currently no mandate to cover CR visits. This is identified as an important change to lobby within the Department of Health mandate provisions.

Implications: Many important health benefits result from participate in CR. Therefore, it is necessary to consider all factors that impact referral rates to the program. Barriers to accessibility to the CR service for patients post PCI can be improved with the interventions described in this project.

Funding acknowledgements: No Financial disclosure

Keywords:
PCI: Percutaneous coronary intervntion

Topics:
Cardiorespiratory

Did this work require ethics approval? No

Reason: This is a quality project as per our research department it does not need approval from ethics committee