In our VitalBlog we frequently share our thoughts and opinions on healthcare-related topics.
Cardiac Rehabilitation By The Numbers
Cardiac rehabilitation has been shown to have significant positive benefits for patients who have had a cardiac event. Those data/numbers include:
- 47% lower risk of reinfarction for individuals who have had a myocardial infarction
- 36% reduction from cardiac related mortality for individuals who have had a myocardial infarction
- 26% decrease in all-risk mortality for individuals who have had a myocardial infarction
- 20-50% reduction in all-cause mortality for individuals who have had a percutaneous coronary intervention or coronary artery bypass
With such dramatic improvements in quantity and quality of life, a number that remains problematic is that approximately 80% of individuals who could benefit from a cardiac rehabilitation program are not referred to one (http://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/01/26/16/25/cardiac-rehabilitation-and-risk-reduction). How can that possibly be true?
There are clearly a number of barriers to fully realizing the potential benefit of cardiac rehabilitation programs including:
- No standard protocols exist for the referral of eligible patients to rehab programs
- A lack of communication between members of the treatment team and the patient leads to lower referral rates
- Unawareness of the value of cardiac rehabilitation by some members of the care team
- Perceived inconvenience on the part of the patient
- Cost and reimbursement for the cardiac rehabilitation program
What can be done to lower or eliminate these barriers?
Fortunately, there are a number of relatively inexpensive tools that can be used to address each of the five barriers. Health care organizations’ IT infrastructure can play a central role in eliminating these barriers. For example:
- IT-enabled standard protocols that identify and push to providers the names of individuals who could benefit from participation in a cardiac rehabilitation program. Such solutions use a combination of standard diagnostic and procedure codes to push to providers or case managers in real-time or near real-time the identity of individuals who are eligible for a cardiac rehab program. Such solutions ensure that eligible patients are considered for the program.
- IT solutions that coordinate the communication between providers (pushing appropriate data/information to the correct provider or care manager) also help to ensure that the perspective of individual providers is obtained in the care of the most complex patients.
- IT solutions that push to providers (based upon locally defined rules/guidelines) the names of individuals who potentially qualify for a cardiac rehab program can also help to educate providers on the value of such programs. Including data on the anticipated decrease in readmission rates and mortality for individual patients will likely dramatically improve the awareness of providers relative to the value of cardiac rehabilitation.
- IT programs can enable remote monitoring of patients and may help to reduce the need for travel to a specific physical site for rehabilitation. Remote monitoring through such IT solutions may include both measures of activity and physical wellbeing (e.g., passive collection of daily weights through Bluetooth- enabled digital scales).
- IT solutions can dramatically lower the cost for provision of cardiac rehabilitation by employing remote monitoring and home rehab. Use of passively collected objective data (e.g., activity measures such as step counters and weight) can be used to trigger automated alerts to ensure care providers remain connected to their patients through the course of their rehab program.
Philips VitalHealth has developed such an IT solution, which is cloud-based and interfaces with a provider’s base EMR to ensure that both patient and provider are not disincentivized from using it.