Attendance and graduation patterns in a group-model health maintenance organization alternative cardiac rehabilitation program.
OBJECTIVE
Poor rates of participation in cardiac rehabilitation programs are well documented, especially among women and older patients. The Colorado Kaiser Permanente Cardiac Rehabilitation (KPCR) program is a home-based, case-managed, goal-oriented program with an active recruitment process and unlimited program length. This study evaluated the participation rates for the program and the predictors of attendance and graduation.


METHODS
Patients hospitalized with acute myocardial infarction, coronary artery bypass graft, and percutaneous coronary intervention from June 1999 to May 2000 (n = 1030) were identified from the administrative database, and the proportion captured by the KPCR staff was determined. Subsequent attendance and graduation patterns were evaluated.


RESULTS
Nearly 94% of patients with one of the three aforementioned conditions were identified by the rehabilitation staff, and 41% of all patients attended the KPCR program. More than 75% of the patients who participated went on to graduate from the program. Gender comparisons showed no difference in participation between men (66.8%) and women (59.7%) (P =.07). Participation rates were inversely associated with age, yet age was not associated with graduation from the program. Surgical interventions and two or more events experienced within the first 4 weeks of the index event were the strongest predictors of attendance and graduation from the KPCR program.


CONCLUSIONS
Innovative approaches for the capture and retention of patients in cardiac rehabilitation programs are urgently needed. The alternative program evaluated in this study showed little difference in participation between men and women, yet participation among older patients remained poor. Overall, patients who underwent surgical interventions or multiple events were more likely to attend and graduate from the program.
Ratchford
Andria M
AM
University of Colorado Health Sciences Center, Denver, USA. andria.ratchford@state.co.us
Hamman
Richard F
RF
Regensteiner
Judith G
JG
Magid
David J
DJ
Gallagher
Stacy Brennan
SB
Merenich
John A
JA
D017677:Age Distribution; D000368:Aged; D019090:Case Management / Q000706:statistics & numerical data; D003120:Colorado; D003327:Coronary Disease / Q000150:complications / Q000534:rehabilitation*; D048909:Diabetes Complications; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome