title: The electronic tracking of referral and attendance at cardiac rehabilitation in Counties Manukau Health: a potential model for New Zealand.
abstract: OBJECTIVE
  Cardiac rehabilitation (CR) programmes for patients surviving an acute coronary syndrome (ACS) event are important and recommended by clinical guidelines. Referral and attendance, however, remain suboptimal and tracking both of these aspects to inform quality improvement has been difficult. The aim of this study was to describe the use of an electronic registry to capture referral and attendance at CR in CMH and to report the characteristics of the initial cohort.
  
  
  METHODS
  We developed and implemented an electronic tracking tool, designed to be compatible with ANZAC-QI to monitor referral and attendance in a cohort of patients with confirmed ACS between 1 January 2013 and 1 January 2015.
  
  
  RESULTS
  Over 90% of patients with confirmed ACS had in-hospital phase 1 CR and three quarters were referred for post-discharge phase 2 CR. Of those with an ACS diagnosis, half attended at least one CR intervention but only a third completed their planned programme. Older patients and women were less likely to be referred for CR and those without in-hospital revascularisation, current smokers and with prior CVD were least likely to attend after referral.
  
  
  CONCLUSIONS
  Despite offering a range of CR options including community, clinic one on one and home based CR, the uptake of CR in patients with ACS remains suboptimal. An electronic tracking process was easy to use and has identified referral and attendance deficits that can be improved. Exploring new models of structured secondary prevention process, alongside encouraging referral and supporting attendance at established CR programmes, will offer benefits.
authors.affiliation: Cardiology Nurse Practitioner, Middlemore Hospital, Counties Manukau District Health Board, Auckland.
authors.forename: Andy
authors.initials: A
authors.lastname: McLachlan
authors.affiliation: Senior Research Fellow Rural Health, Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin.
authors.forename: Fiona
authors.initials: F
authors.lastname: Doolan-Noble
authors.affiliation: Health Analyst, Middlemore Hospital, Auckland.
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.affiliation: Cardiology Nurse Specialist, Middlemore Hospital, Counties Manukau District Health Board, Auckland.
authors.forename: Katherine
authors.initials: K
authors.lastname: McLean
authors.affiliation: Cardiologist, Middlemore Hospital, Counties Manukau District Health Board, Auckland.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
mesh_terms: D054058:Acute Coronary Syndrome / Q000534:rehabilitation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010349:Patient Compliance / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D011795:Surveys and Questionnaires; D055815:Young Adult