title: Improving cardiac rehabilitation attendance and completion through quality improvement activities and a motivational program.
abstract: OBJECTIVE
  Recent studies have demonstrated that patients who attend more cardiac rehabilitation (CR) sessions have lower subsequent mortality rates than those who attend fewer sessions.
  
  
  METHODS
  We analyzed the impact of several phased-in policy and process changes implemented to increase patient participation in CR. In March 2010, our CR program changed from a policy of individualizing the recommended number of CR sessions per patient to a policy that recommended all 36 CR sessions. In October 2010, we introduced a 7-minute video describing the benefits of CR. In August 2011, we introduced a motivational program that rewarded patients after every sixth CR session. The number of CR sessions attended was determined through review of billing records. Enrollment and completion were defined as attending ≥1 session and ≥30 sessions, respectively.
  
  
  RESULTS
  We identified 1103 patients sequentially enrolled in CR between May 2009 and January 2012. Overall, the median number of sessions per patient improved from 12 to 20 (P < .001). Completion rate improved from 14% to 39% (P < .001). The motivational program increased attendance by a median of 3 sessions per patient (P = .04), but this effect was limited to local CR participants. Financial analysis suggested that for every $100 spent on motivational rewards, patients attended an additional 6.6 (95% CI, -1 to 14) sessions of CR.
  
  
  CONCLUSIONS
  Quality improvement activities significantly increased CR participation. Wide implementation of such programs may favorably impact patient participation in CR and potentially decrease the rate of subsequent cardiac events.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.forename: Lezlie L
authors.initials: LL
authors.lastname: Johnson
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Barr
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Daniels
authors.forename: Anne D
authors.initials: AD
authors.lastname: Wolter
authors.forename: Ray W
authors.initials: RW
authors.lastname: Squires
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Perez-Terzic
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000379:methods*; D026741:Physical Therapy Modalities / Q000523:psychology*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States