title: Effects of cardiac rehabilitation referral strategies on referral and enrollment rates.
abstract: Despite recommendations in clinical practice guidelines, evidence suggests that utilization of cardiac rehabilitation (CR) following indicated cardiac events is low. Referral strategies, such as automatic referral, have been advocated to improve CR utilization. In this Review, we evaluate the effects of referral strategies on rates of CR referral and enrollment. Referral strategies are categorized as 'automatic' (the use of electronic health records or systematic discharge order sets), as 'liaison' (discussions with allied health-care providers), or as 'other' (for example, the use of motivational letter to patients). The highest rates of CR referral have been achieved in studies implementing automatic referral orders, whereas the highest rates of CR enrollment have resulted from a combination of automatic and liaison methods. Overall, innovative referral strategies significantly increase CR utilization. While further investigation is needed, institutions should evaluate their CR referral practice in light of these findings.
authors.affiliation: Faculty of Health, 368 Norman Bethune College, York University, Toronto, ON M3J 1P3, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Gravely-Witte
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Leung
authors.forename: Rajiv
authors.initials: R
authors.lastname: Nariani
authors.forename: Hala
authors.initials: H
authors.lastname: Tamim
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Chan
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D057286:Electronic Health Records; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000517:prevention & control / Q000534:rehabilitation*; D006801:Humans; D009042:Motivation; D010349:Patient Compliance; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D017010:Reminder Systems; D055502:Secondary Prevention