title: The role of systematic inpatient cardiac rehabilitation referral in increasing equitable access and utilization.
abstract: BACKGROUND
  While systematic referral strategies have been shown to significantly increase cardiac rehabilitation (CR) enrollment to approximately 70%, whether utilization rates increase among patient groups who are traditionally underrepresented has yet to be established. This study compared CR utilization based on age, marital status, rurality, socioeconomic indicators, clinical risk, and comorbidities following systematic versus nonsystematic CR referral.
  
  
  METHODS
  Coronary artery disease inpatients (N = 2635) from 11 Ontario hospitals, utilizing either systematic (n = 8 wards) or nonsystematic referral strategies (n = 8 wards), completed a survey including sociodemographics and activity status. Clinical data were extracted from charts. At 1 year, 1680 participants completed a mailed survey that assessed CR utilization. The association of patient characteristics and referral strategy on CR utilization was tested using χ.
  
  
  RESULTS
  When compared to nonsystematic referral, systematic strategies resulted in significantly greater CR referral and enrollment among obese (32 vs 27% referred, P = .044; 33 vs 26% enrolled, P = .047) patients of lower socioeconomic status (41 vs 34% referred, P = .026; 42 vs 32% enrolled, P = .005); and lower activity status (63 vs 54% referred, P = .005; 62 vs 51% enrolled, P = .002). There was significantly greater enrollment among those of lower education (P = .04) when systematically referred; however, no significant differences in degree of CR participation based on referral strategy.
  
  
  CONCLUSIONS
  Up to 11% more socioeconomically disadvantaged patients and those with more risk factors utilized CR where systematic processes were in place. They participated in CR to the same high degree as their nonsystematically referred counterparts. These referral strategies should be implemented to promote equitable access.
authors.affiliation: Kinesiology and Health Science, 368 Bethune College, York University, Toronto, Ontario, Canada. sgrace@yorku.ca
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Leung
authors.forename: Robert
authors.initials: R
authors.lastname: Reid
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.forename: Gilbert
authors.initials: G
authors.lastname: Wu
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.lastname: CRCARE Investigators
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D007297:Inpatients; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009864:Ontario; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D057566:Self Report; D012959:Socioeconomic Factors