Hospital and Operator Variation in Cardiac Rehabilitation Referral and Participation After Percutaneous Coronary Intervention: Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Sukul, Devraj; Seth, Milan; Thompson, Michael P.; Keteyian, Steven J.; Boyden, Thomas F.; Syrjamaki, John; Yaser, Jessica; Likosky, Donald S.; Gurm, Hitinder S.

doi:10.1161/circoutcomes.121.008242

Cited by 15 publications

(14 citation statements)

References 28 publications

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“…We investigated the participants who were restricted after PCI. Post-PCI patients urgently need self-management to improve clinical outcomes, such as reducing depression and anxiety, reducing mortality and morbidity, and improving health-related quality of life (HRQoL) [ 68 ]. Compared with a former systematic review, exercise training is a core component in previous studies, but we performed this including some multidisciplinary interventions and multifaceted care, such as physical exercise, nutritional advice, and target-driven pharmacological therapies.…”

Section: Discussionmentioning

confidence: 99%

Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Zhang

et al. 2023

BMC Cardiovasc Disord

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Background Recent advances in telecommunications technology have raised the possibility of telehealth intervention delivering cardiac telerehabilitation, which may provide the efficacy of health services in patients after percutaneous coronary intervention (PCI). This study aimed to investigate the effects of home-based cardiac telerehabilitation (HBCTR) in patients undergoing PCI. Methods We performed a comprehensive search of the following electronic databases: PubMed, Cochrane Central, Web of Science, Embase, CNKI, and WANFANG. For the prespecified outcomes, the primary outcomes were results of physical function (the six-minute walking test, 6MWT) and quality of life (QoL) of the participants. The secondary outcomes were results of (1) blood pressure; (2) full lipid profile (3) reliable assessment of anxiety and depression in patients. Results All studies were conducted between 2013 and 2022, and a total of 5 articles could be included in the quantitative meta-analysis. The results showed that there was a statistically significant difference between the HBCTR intervention group and the control group in 6WMT (MD 16.59, 95%CI 7.13 to 26.06, P = 0.0006), but there was no difference in QoL (SMD − 0.25, 95%CI − 1.63 to 1.13, P = 0.73). According to the fixed effects model, there was a statistically significant difference between the HBCTR group versus the control group (MD − 2.88, 95%CI − 5.19 to − 0.57, P = 0.01), but not in diastolic blood pressure. Likewise, significant improvements of triglycerides and in low-density lipoprotein cholesterol were observed in HBTCR groups, but no significant differences were observed regarding total cholesterol and high-density lipoprotein cholesterol. Conclusion This systematic review and meta-analysis have proven that the HBCTR is one of the promisingly effective cardiac rehabilitation strategies that improve cardiorespiratory fitness and reduce cardiovascular disease risk factors. With the continuous improvement of the telerehabilitation network, it is expected to serve in clinical.

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Section: Discussionmentioning

confidence: 99%

Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Zhang

et al. 2023

BMC Cardiovasc Disord

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“…Our recent work suggests that physicians play an important role in ensuring CR referral and downstream utilization. 31 Understanding physician attitudes toward CR may also be an important step in identifying opportunities for improvement. Administering validated instruments to physicians, such as the Provider Attitudes Toward Cardiac Rehabilitation and Referral survey, and linking them to existing clinical and claims data may provide these insights.…”

Section: Discussionmentioning

confidence: 99%

“…Involving patients in the process of quality improvement will help inform these best practices and guide efforts to achieve patient-centered solutions. Our recent work suggests that physicians play an important role in ensuring CR referral and downstream utilization 31. Understanding physician attitudes toward CR may also be an important step in identifying opportunities for improvement.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Feasibility of a Statewide Collaboration to Improve Cardiac Rehabilitation Participation

Thompson

Yaser

Forrest

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

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Statewide Collaboration to Improve CR E75 E xercise-based cardiac rehabilitation (CR) is an underutilized service with well-documented clinical and functional benefits for patients with cardiovascular disease. 1-4 Despite strong recommendations supporting its use across a spectrum of cardiovascular conditions and procedures, only a quarter of eligible patients attend a single session of CR and even fewer patients complete the recommended 36 CR sessions. [5][6][7][8][9] Participation in CR varies on the basis of age, race, sex, type of qualifying event, type of health insurance, discharging hospital, and geographic region, suggesting opportunities for targeted quality improvement efforts. [10][11][12][13][14][15][16][17][18][19] Professional societies and federal agencies have set national goals for CR enrollment, developed a road map and resources to achieve this goal, and created valid and reliable performance measures to benchmark CR performance, yet significant and sustained improvement in CR participation remains elusive. [20][21][22] Regional quality improvement collaboratives may provide one solution to improving CR participation and quality through benchmarking performance and facilitating quality improvement efforts. In Michigan, statewide collaborative quality initiatives (CQIs) were developed as a partnership between hospitals, physicians, and a large private insurer with the goal of improving quality and costs of care through data collection and the sharing of best practices. 23 For almost 25 yr, the CQI model has demonstrated success in evaluating and improving the quality of care for patients undergoing cardiovascular procedures. [24][25][26][27][28][29] For example, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), a CQI focused on improving outcomes after percutaneous coronary intervention (PCI), reduced the risk-adjusted rate of acute kidney injury after PCI from 3.3% in 2010 to 2.5% in 2016 through the development and sharing of best practices around identifying patient-specific contrast thresholds and emphasizing periprocedural hydration. 30 In this spirit, the BMC2 partnered with another CQI, the Michigan Value Collaborative (MVC), to identify and evaluate variation in the use of CR after PCI, coronary artery bypass grafting (CABG), and medically managed acute myocardial infarction (AMI) using clinical and claims data registries. 10,11,31 Establishing engagement across inpatient and outpatient settings using the CQI model is a needed step to assist with improving CR enrollment and quality.

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“…Though literature on post-PCI CR use demonstrates that even with rich clinical data, there is significant hospital-level variation in CR participation. 39…”

Section: Discussionmentioning

confidence: 99%

Variation in Cardiac Rehabilitation Participation During Aortic Valve Replacement Episodes of Care

Guduguntla

Yaser

Keteyian

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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Background: Despite reported benefit in the setting of aortic valve replacement (AVR), cardiac rehabilitation (CR) utilization remains low, with few studies evaluating hospital and patient-level variation in CR participation. We explored determinants of CR variability during AVR episodes of care: transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Methods: A cohort of 10,124 AVR episodes of care (TAVR n=5,121 from 24 hospitals; SAVR n=5,003 from 32 hospitals) were identified from the Michigan Value Collaborative statewide multipayer registry (2015 to 2019). CR enrollment was defined as the presence of a single professional or facility claim within 90 days of discharge: 93797, 93798, G0422, G0423. Annual trends and hospital variation in CR were described for TAVR, SAVR, and all AVR. Multilevel logistic regression was used to estimate effects of predictors and hospital risk-adjusted rates of CR enrollment. Results: Overall, 4,027 (39.8%) patients enrolled in CR, with significant differences by treatment strategy: SAVR=50.9%, TAVR=28.9% (p<0.001). CR use after SAVR was significantly higher than after TAVR and increased over time for both modalities (p<0.001). There were significant differences in CR enrollment across age, gender, payer, and some comorbidities (p<.05). At the hospital-level, CR participation rates for all AVR varied 10-fold (4.8% to 68.7%) and were moderately correlated between SAVR and TAVR (Pearson r =0.56, p<0.01). Conclusions: Substantial variation exists in CR participation during AVR episodes of care across hospitals. However, within-hospital CR participation rates were significantly correlated across treatment strategies. These findings suggest that CR participation is the product of hospital-specific practice patterns. Identifying hospital practices associated with higher CR participation can help assist future quality improvement efforts to increase CR use after AVR.

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Hospital and Operator Variation in Cardiac Rehabilitation Referral and Participation After Percutaneous Coronary Intervention: Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Cited by 15 publications

References 28 publications

Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Evaluating the Feasibility of a Statewide Collaboration to Improve Cardiac Rehabilitation Participation

Variation in Cardiac Rehabilitation Participation During Aortic Valve Replacement Episodes of Care

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