Decisive Bearing of Organizational Dynamics on the Application and Success of Hospital-Based Cardiac Rehabilitation

Journal of Cardiopulmonary Rehabilitation and Prevention

Jackson²,

Grandis³

et al. 2022

In-Person, Hybrid, and Virtual Cardiac Rehabilitation 1 C ardiac rehabilitation (CR) reduces hospitalizations and mortality and improves functional status and quality of life for patients with cardiovascular disease. [1][2][3][4][5][6][7][8][9][10] Despite its benefits, only 24% of eligible patients participate in CR. [11][12][13] Indeed, on a global level, CR is only offered in roughly 50% of countries. 14 Root causes of low participation include patient financial and logistic barriers, bias in referrals, and limited program capacity, among others. [15][16][17][18][19] Up to 14% of adults live in an area without a CR center, and even if all CR centers operated at 110% capacity, only 40% of eligible patients could be served. 20 Cardiac rehabilitation holds tremendous promise but is underutilized and, often, unavailable.In an effort to make CR more accessible, the delivery of CR has evolved to include both traditional in-person sessions and newer virtual sessions. [21][22][23][24][25][26][27] Programs may offer virtual sessions only or a hybrid of in-person and virtual sessions. 28 Evidence continues to build that virtual and hybrid CR offer similar safety and efficacy compared with in-person CR. 9,[29][30][31][32][33][34][35][36] The COVID-19 pandemic has accelerated the adoption of virtual and hybrid CR in response to limited or suspended in-person services. 37 Nonetheless, there have been few studies that compare outcomes among in-person, hybrid, and virtual CR in clinical practice, representing a real-world setting. At the University of California, San Francisco (UCSF), the COVID-19 public health emergency necessitated the creation of a CR program that gave patients the choice to limit in-person CR visits and receive much, or all, of their CR virtually. This presented a unique opportunity to compare clinical outcomes between in-person, hybrid, and virtual CR at a single academic center.Our primary objective was to compare, in UCSF CR patients, the association of in-person, hybrid, and virtual CR with change in functional capacity between enrollment and completion, measured by distance completed on the 6-min walk test (6MWT). We hypothesized that change in the 6MWT would be similar between the in-person, hybrid, and virtual CR cohorts. In addition, we compared attainment of blood pressure (BP) control, change in waistto-hip ratio, depressive symptoms, anxiety symptoms, and cardiac self-efficacy. We also described completion rates, adverse events, and patient and staff qualitative perceptions of CR. METHODSThis cohort study included all patients who enrolled in CR at the UCSF between October 22, 2019, and May 10, 2021. All subjects were ≥18 yr men and women, and all races, ethnicities, and spoken languages were included. There were no specific inclusion or exclusion criteria related to education, literacy, or technology use. The study was reviewed and approved by the UCSF Institutional Review Board . Quantitative data were collected from electronic health records collected for patient care purposes, and written ...

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Qualitative Perceptions of In-person, Hybrid, and Virtual Cardiac Rehabilitation

Journal of Cardiopulmonary Rehabilitation and Prevention

Jackson²,

Grandis³

et al. 2022

“…Previous work has reported that factors such as leadership support, funding, and institutional contribute to CR delivery. 26,27 This study adds further qualitative data to support these facilitators, and adds information on organizational factors that contribute to technology adoption for CR programs, including equipment and work ow modi cations for CR staff.…”

Section: Narrative Description Of Cr Experiencementioning

confidence: 92%

Home-Based Cardiac Rehabilitation During COVID-19: A Qualitative Study

Tse

2021

Preprint

Background: Cardiac rehabilitation (CR) has been shown to reduce mortality, morbidity, and hospitalizations. Increasingly, digital tools have augmented the ease of delivering programs outside of the traditional rehabilitation center setting. Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). In this study, we qualitatively evaluated implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications.Methods: Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research.Results: A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use.Conclusions: Individually tailored HBCR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.

“…Previous work has reported that factors such as leadership support, funding, and institutional contribute to CR delivery. 24,25 This study adds further qualitative data to support these facilitators, and adds information on organizational factors that contribute to technology adoption for CR programs, including equipment and work ow modi cations for CR staff.…”

Section: Narrative Description Of Cr Experiencementioning

confidence: 93%

A Qualitative Study of Home-Based and Hybrid Cardiac Rehabilitation During COVID-19

Tse

2021

Preprint

Background: Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). In this study, we qualitatively evaluated implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications.Methods: Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research. Results: A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use.Conclusions: Individually tailored HBCR or hybrid CR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.