title: An electronic cardiac rehabilitation referral system increases cardiac rehabilitation referrals.
abstract: OBJECTIVE
  Although cardiac rehabilitation attendance is associated with improved clinical outcomes for patients after acute myocardial infarction (AMI), it remains underutilized nationally. We sought to determine whether replacing traditional, paper-based referrals for cardiac rehabilitation for patients with AMI with an electronic referral system would increase utilization.
  
  
  RESULTS
  We implemented the change from traditional, paper-based referrals to electronic referrals at the Massachusetts General Hospital on 10 December 2013. Using a segmented regression approach to control for other secular effects, we assessed an association between the intervention and inpatient referrals, total referrals, cardiac rehabilitation attendance at Massachusetts General Hospital, and the rate of inpatient referral to cardiac rehabilitation after AMI. We analyzed 1895 referral records over a 30-month period. After the intervention, the total referrals to our cardiac rehabilitation program increased by a factor of 1.8, largely attributable to a 17-fold increase in inpatient referrals (P<0.0001 for both).
  
  
  CONCLUSIONS
  Even relative to pre-existing secular trends, switching to an electronic referral system was associated with an increase in referral volume for cardiac rehabilitation for patients with AMI. Electronic care innovations may improve the ability of provider organizations to provide guideline-oriented care for patients with coronary artery disease.
authors.affiliation: aHarvard Medical School bDepartment of Medicine, Cardiology Division cCenter for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston dThe Broad Institute of MIT and Harvard, Cambridge eMassachusetts General Physicians Organization, Massachusetts, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Pirruccello
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Traynor
authors.forename: Pradeep
authors.initials: P
authors.lastname: Natarajan
authors.forename: Carol
authors.initials: C
authors.lastname: Brown
authors.forename: Michael K
authors.initials: MK
authors.lastname: Hidrue
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Rosenfield
authors.forename: Sekar
authors.initials: S
authors.lastname: Kathiresan
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
mesh_terms: D000072038:Cardiac Rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006753:Hospital Records / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000534:rehabilitation*; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies