title: Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial.
abstract: OBJECTIVE
  To describe (1) cardiac rehabilitation (CR) referral across cardiac units in a tertiary centre with eReferral; (2) characteristics associated with CR referral and enrolment and (3) the effects of peer navigation (PN) on referral and enrolment. This pilot was a 2 parallel-arm, randomised, single-blind trial with allocation concealment.
  
  
  METHODS
  3 cardiac units (ie, interventional, general cardiology, and cardiac surgery) in 1 of 2 hospitals of a tertiary centre.
  
  
  METHODS
  CR-eligible adult cardiac inpatients were randomised to PN or usual care. 94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN. Outcomes were ascertained in 76 (80.9%) participants.
  
  
  METHODS
  The PN (1) visited participant at the bedside, (2) mailed a card to participant's home reminding about CR and (3) called participant 2 weeks postdischarge to discuss CR barriers.
  
  
  METHODS
  The primary outcome of enrolment was defined as participant attendance at a scheduled CR intake appointment (yes/no). The secondary outcome was referral. Blinded outcome assessment was conducted 12 weeks postdischarge, via CR chart extraction.
  
  
  RESULTS
  Those who received care on the cardiac surgery unit (77.9%) were more likely to be referred than those treated on the general cardiology (61.1%) or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery, hypertension and hyperlipidaemia were significantly more likely, and those with congenital heart disease, cancer and a previous cardiac diagnosis were less likely to be referred. Participants referred to a site closer to home (76.2% of those referred) were more likely to enrol than those not (23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment (46.0%, p=0.24).
  
  
  CONCLUSIONS
  There is wide variability in CR referral, even within academic centres, and despite eReferral. Referral was quite high, and thus, PN did not improve CR utilisation. Results support triaging patients to the CR programme closest to their home.
  
  
  BACKGROUND
  NCT02204449; Results.
authors.affiliation: York University, Toronto, Ontario, Canada Stony Brook University, Program in Public Health, Stony Brook Medicine, School of Health, Technology and Management, Stony Brook, New York, USA.
authors.forename: Sobia F
authors.initials: SF
authors.lastname: Ali-Faisal
authors.affiliation: Stony Brook University, Program in Public Health, Stony Brook Medicine, School of Health, Technology and Management, Stony Brook, New York, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Benz Scott
authors.affiliation: School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Johnston
authors.affiliation: School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D003362:Cost-Benefit Analysis; D057286:Electronic Health Records; D005260:Female; D006331:Heart Diseases / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D062526:Patient Navigation; D010865:Pilot Projects; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016037:Single-Blind Method; D062606:Tertiary Care Centers
keywords: Health Services Research; Patient Navigation; Physical and Rehabilitation Medicine; Referral