System-level factors and use of cardiac rehabilitation.
OBJECTIVE
Despite well-established benefits, only 10% to 20% of eligible candidates in the United States currently use formal cardiac rehabilitation (CR) services. Existing studies identify both patient- and provider-level barriers to physician referral and patient uptake. This study, which was driven by new evidence indicating that utilization rates vary enormously from state to state, within states, and from hospital to hospital, explores the relationship between system-level factors and CR use.


METHODS
Using a qualitative design with semistructured questions, we telephone-interviewed both directors of CR facility programs and presidents of CR state associations operating in states with high and low rates of CR use. We explored the political and cultural environment in which CR facilities operate and the technical capacity to secure referrals and convert referrals to enrollment.


RESULTS
We identified 4 system-level factors that may help explain regional variation in CR use. These included the degree of automation and assertiveness around securing CR referrals, level of integration of CR within the hospital setting and physician community, relationship to other CR facilities, and capacity constraints.


CONCLUSIONS
As some of the identified system-level factors can be altered by public and hospital-level policy, study results suggest opportunities for interventions and directions for future research that could increase the use of CR.
Gurewich
Deborah
D
Brandeis University, Waltham, Massachusetts 02454, USA. gurewich@brandeis.edu
Prottas
Jeffrey
J
Bhalotra
Sarita
S
Suaya
Jose A
JA
Shepard
Donald S
DS
D005081:Exercise Therapy / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012046:Rehabilitation / Q000706:statistics & numerical data*; D014481:United States