Delivery of outpatient cardiac rehabilitation in a managed care organization.
OBJECTIVE
This study aimed to assess referral and enrollment rates for postdischarge outpatient cardiac rehabilitation in a managed care organization.


METHODS
A prospective cohort study investigated Atlanta area managed care members, age 30 years or older, hospitalized for acute myocardial infarction or coronary revascularization during 1997-1999. Postdischarge cardiology medical records were abstracted for evidence of postdischarge visits; counseling on diet, weight, or exercise; and referral to outpatient cardiac rehabilitation. Enrollment in outpatient cardiac rehabilitation was confirmed by chart abstraction. Referral and enrollment rates were estimated using logistic regression models.


RESULTS
Of the 945 hospitalized patients, 783 remained alive and enrolled in the managed care organization 12 months after discharge. Of these 783 patients, 73.8% had at least one postdischarge cardiologist visit. Among these, 24.4% were referred by a cardiologist to outpatient cardiac rehabilitation, and 7.1% enrolled. Enrollment was significantly higher among patients with a documented referral than among patients not referred (P <.05). Patients 65 years of age or older were significantly less likely than younger patients to be referred to cardiac rehabilitation and enroll (P<.05). Of the patients with a postdischarge cardiologist visit, 31.5% received counseling on diet, weight, or exercise. The men and the patients with a body mass index of at least 30 were more likely to receive this counseling than women and those with body mass index less than 30 (P <.05).


CONCLUSIONS
The low rates of referral and enrollment for postdischarge outpatient cardiac rehabilitation in this managed care population are consistent with rates observed at academic medical centers. Despite demonstrated benefits after acute coronary events, outpatient cardiac rehabilitation remains underused.
Roblin
Douglas
D
Kaiser Permanente, Atlanta, Ga 30305, USA. Douglas.Roblin@kp.org
Diseker
Robert A
RA
Orenstein
Diane
D
Wilder
Myrtle
M
Eley
Melanie
M
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D015331:Cohort Studies; D003376:Counseling / Q000706:statistics & numerical data; D003695:Delivery of Health Care; D004032:Diet; D015444:Exercise / Q000502:physiology; D005260:Female; D005845:Georgia; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D017678:Sex Distribution