title: Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study.
abstract: BACKGROUND
  Despite the evidence of benefit, cardiac rehabilitation (CR) remains highly underutilized. The present study examined the effect of two inpatient and one outpatient strategy on CR utilization: allied healthcare provider completion of referral (a policy that had been endorsed and approved by the cardiac program leadership in advance; PRE-APPROVED); CR intake appointment booked before hospital discharge (PRE-BOOKED); and early outpatient education provided at the CR program shortly after inpatient discharge (EARLY ED).In this prospective observational study, 2,635 stable cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey, and clinical data were extracted from charts. One year later, participants were a mailed survey that assessed CR use. Participating inpatient units and CR programs to which patients were referred were coded to reflect whether each of the strategies was used (yes/no). The effect of each strategy on participants' CR referral and enrollment was examined using generalized estimating equations.
  
  
  RESULTS
  A total of 1,809 participants completed the post-test survey. Adjusted analyses revealed that the implementation of one of the inpatient strategies was significantly related to greater referral and enrollment (PRE-APPROVED: OR = 1.96, 95%CI = 1.26 to 3.05, and OR = 2.91, 95%CI = 2.20 to 3.85, respectively). EARLY ED also resulted in significantly greater enrollment (OR = 4.85, 95%CI = 2.96 to 7.95).
  
  
  CONCLUSIONS
  These readily-implementable strategies could significantly increase access to and enrollment in CR for the cardiac population. The impact of these strategies on wait times warrants exploration.
authors.affiliation: School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Canada. sgrace@yorku.ca
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Angevaare
authors.forename: Robert D
authors.initials: RD
authors.lastname: Reid
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.forename: Sonia
authors.initials: S
authors.lastname: Anand
authors.forename: Milan
authors.initials: M
authors.lastname: Gupta
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brister
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
mesh_terms: D000367:Age Factors; D000368:Aged; D001071:Appointments and Schedules; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D006801:Humans; D007297:Inpatients; D008875:Middle Aged; D009864:Ontario; D010045:Outpatients; D010346:Patient Care Management / Q000458:organization & administration; D010353:Patient Education as Topic / Q000458:organization & administration; D062645:Percutaneous Coronary Intervention / Q000534:rehabilitation*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration*; D012737:Sex Factors; D012959:Socioeconomic Factors