title: Effect of a computerized referral at hospital discharge on cardiac rehabilitation participation rates.
abstract: OBJECTIVE
  We evaluated the effectiveness of a computerized cardiac rehabilitation (CR) recruiting strategy instituted during the hospital discharge process after acute myocardial infarction (MI) or coronary artery bypass graft (CABG) surgery. The computerized referral was designed to enhance an already-established nurse-based recruiting strategy that included personalized, in-hospital visits.
  
  
  METHODS
  We determined CR participation rates before and after the implementation of the computerized referral process. The computerized intervention included a personalized letter at hospital discharge and a scheduled group introductory visit at the CR center. Data sources for the study included hospital electronic medical records, the hospital discharge summary, and the CR enrollment database
  
  
  RESULTS
  Before the study intervention, 47% (171/364) of patients participated in the CR program, whereas, in year 2, this increased to 53% (231/440) (adjusted P < .01, odds ratio of participation = 1.49, 95% confidence interval = 1.11-1.99). Participation rates increased more in patients after MI (39%-48%, P < .05) than after CABG surgery (63%-67%, P = .69). During each time period, enrollment was higher after CABG surgery than after MI.
  
  
  CONCLUSIONS
  Despite an aggressive baseline recruiting strategy, the addition of a computerized referral process during hospital discharge planning resulted in increased CR participation rates. These results strongly support the institution of computerized referral processes to CR during the hospital discharge planning process.
authors.affiliation: Division of Cardiology, University of Vermont College of Medicine and Fletcher-Allen Health Care, Burlington, VT 05403, USA.
authors.forename: Enkhtuyaa
authors.initials: E
authors.lastname: Mueller
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Savage
authors.forename: David J
authors.initials: DJ
authors.lastname: Schneider
authors.forename: Laura L
authors.initials: LL
authors.lastname: Howland
authors.forename: Philip A
authors.initials: PA
authors.lastname: Ades
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D005260:Female; D006751:Hospital Information Systems; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000534:rehabilitation*; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011446:Prospective Studies; D012017:Referral and Consultation; D014481:United States