Attendance and graduation patterns in a group-model health maintenance organization alternative cardiac rehabilitation program.

PURPOSE Poor rates of participation in cardiac rehabilitation programs are well documented, especially among women and older patients. The Colorado Kaiser Permanente Cardiac Rehabilitation (KPCR) program is a home-based, case-managed, goal-oriented program with an active recruitment process and unlimited program length. This study evaluated the participation rates for the program and the predictors of attendance and graduation. METHODS Patients hospitalized with acute myocardial infarction, coronary artery bypass graft, and percutaneous coronary intervention from June 1999 to May 2000 (n = 1030) were identified from the administrative database, and the proportion captured by the KPCR staff was determined. Subsequent attendance and graduation patterns were evaluated. RESULTS Nearly 94% of patients with one of the three aforementioned conditions were identified by the rehabilitation staff, and 41% of all patients attended the KPCR program. More than 75% of the patients who participated went on to graduate from the program. Gender comparisons showed no difference in participation between men (66.8%) and women (59.7%) (P =.07). Participation rates were inversely associated with age, yet age was not associated with graduation from the program. Surgical interventions and two or more events experienced within the first 4 weeks of the index event were the strongest predictors of attendance and graduation from the KPCR program. CONCLUSIONS Innovative approaches for the capture and retention of patients in cardiac rehabilitation programs are urgently needed. The alternative program evaluated in this study showed little difference in participation between men and women, yet participation among older patients remained poor. Overall, patients who underwent surgical interventions or multiple events were more likely to attend and graduate from the program.

[1]  D. Polk,et al.  Referral patterns and exercise response in the rehabilitation of female coronary patients aged ≥62 years , 1992 .

[2]  W. Rosamond,et al.  Predictors of outpatient cardiac rehabilitation utilization: the Minnesota Heart Surgery Registry. , 1998, Journal of cardiopulmonary rehabilitation.

[3]  R. Krauss,et al.  Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). , 1994, Circulation.

[4]  D. Gray,et al.  Cardiac rehabilitation: socially deprived patients are less likely to attend but patients ineligible for thrombolysis are less likely to be invited , 1999, Heart.

[5]  K. Teo,et al.  Cardiac rehabilitation: the forgotten intervention. , 1999, The Canadian journal of cardiology.

[6]  S. Moore Women's views of cardiac rehabilitation programs. , 1996, Journal of cardiopulmonary rehabilitation.

[7]  C. Dennis,et al.  A Case-Management System for Coronary Risk Factor Modification after Acute Myocardial Infarction , 1994, Annals of Internal Medicine.

[8]  K. Adamo,et al.  Sex differences in cardiac rehabilitation. , 2000, The Canadian journal of cardiology.

[9]  C. Lamendola,et al.  National Survey on Gender Differences in Cardiac Rehabilitation Programs. Patient characteristics and enrollment patterns. , 1996, Journal of cardiopulmonary rehabilitation.

[10]  Optimizing treatment of dyslipidemia in patients with coronary artery disease in the managed-care environment (the Rocky Mountain Kaiser Permanente experience). , 2000, The American journal of cardiology.

[11]  K. McKenna,et al.  Rehabilitation outcomes following percutaneous coronary interventions (PCI). , 2001, Patient education and counseling.

[12]  B. Franklin,et al.  Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation. , 2000, The American journal of cardiology.

[13]  T. Ryan,et al.  Comparison of the clinical profile and outcome of women and men in cardiac rehabilitation. , 1992, The American journal of cardiology.

[14]  C. Lavie,et al.  Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort. , 1995, The American journal of cardiology.

[15]  G. Blackburn,et al.  Cardiac rehabilitation participation patterns in a large, tertiary care center: evidence for selection bias. , 2000, Journal of cardiopulmonary rehabilitation.

[16]  L. Lieberman,et al.  Cardiac rehabilitation: gender differences in factors influencing participation. , 1998, Journal of women's health.

[17]  P. Ades,et al.  Predictors of cardiac rehabilitation participation in older coronary patients. , 1992, Archives of internal medicine.

[18]  K. Lee,et al.  Importance of baseline functional and socioeconomic factors for participation in cardiac rehabilitation. , 1995, The American journal of cardiology.

[19]  K. Burns,et al.  Predictors of Referral to Cardiac Rehabilitation and Cardiac Exercise Self-Efficacy , 1998, Clinical nursing research.

[20]  N. Wenger Rehabilitation of the coronary artery disease patient: capturing patients. , 1997, The American journal of cardiology.

[21]  C. Lavie,et al.  Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women. , 1995, The American journal of cardiology.

[22]  C. Lavie,et al.  Benefits of cardiac rehabilitation and exercise training in elderly women. , 1997, The American journal of cardiology.

[23]  J. Spertus,et al.  Outpatient nursing case management for cardiovascular disease. , 2000, The Nursing clinics of North America.