title: The role of clinical and geographic factors in the use of hospital versus home-based cardiac rehabilitation.
abstract: Cardiac rehabilitation (CR) is most often provided in a hospital setting. Home-based models of care have been developed to overcome geographic, among other, barriers in patients at a lower risk. This study assessed whether clinical and geographic factors were related to the use of either a hospital-based or a home-based program. Secondary analysis was undertaken within a study of 1268 cardiac outpatients recruited from 97 cardiologist practices where clinical data were extracted. Participants completed a survey including the Duke Activity Status Index. They reported CR utilization in a second survey mailed 9 months later, including CR site and program model. Geographic information systems were used to determine the distances and the drive times to the CR site attended from patients' homes. Overall, 469 (37.0%) participants attended CR at one of 41 programs. Of the 373 (79.5%) participants with complete geographic data, 43 (11.5%) reported attending home-based CR. The sole clinical difference was in activity status, where patients attending a hospital-based program had lower activity status (P<0.01). There were no differences in model attended on the basis of geographic parameters including urban versus rural dwelling or drive times (P>0.05). In conclusion, only one-tenth of outpatients participated in a home-based program, and this allocation was unrelated to geographic considerations. Although patients should continue to be appropriately triaged on the basis of clinical risk to ensure safety, more targeted allocation of patients to home-based services may be warranted. This may optimize the degree of participation and potentially patient outcomes.
authors.affiliation: Department of Geography, Queen's University, Kingston, Canada.
authors.forename: Janette
authors.initials: J
authors.lastname: Brual
authors.forename: Shannon
authors.initials: S
authors.lastname: Gravely
authors.forename: Neville
authors.initials: N
authors.lastname: Suskin
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D017598:Efficiency, Organizational; D005260:Female; D006331:Heart Diseases / Q000534:rehabilitation*; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010349:Patient Compliance; D012046:Rehabilitation / Q000458:organization & administration; D012189:Retrospective Studies; D014186:Transportation