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Enhancing Referrals, Enrollment and Outcomes in Cardiac Rehabilitation The Duke Experience

Enhancing Referrals, Enrollment and Outcomes in Cardiac Rehabilitation The Duke Experience . William E. Kraus, MD The Duke Cardiac Rehabilitation Team. NC Cardiopulmonary Rehabilitation Association Symposium Chapel Hill, NC 2 March 2011. State of the Art.

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Enhancing Referrals, Enrollment and Outcomes in Cardiac Rehabilitation The Duke Experience

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  1. Enhancing Referrals, Enrollment and Outcomes in Cardiac Rehabilitation The Duke Experience William E. Kraus, MD The Duke Cardiac Rehabilitation Team NC Cardiopulmonary Rehabilitation Association Symposium Chapel Hill, NC 2 March 2011

  2. State of the Art Opportunity Provided by Readmissions

  3. Recent News

  4. Referrals Automatic CPOE-based

  5. CPOE Prompt • Cardiac rehab prompt field was added to CPOE in August 2008 at Duke • This prompt was displayed as part of the cardiology admission order set. • It displayed eligibility criteria for cardiac rehab and served as a reminder to place a referral for appropriate patients.

  6. Analyses • Data collected during the 5 months prior to institution of CPOE prompt were compared to data collected during the 5 months after institution of CPOE reminder • Number of referrals to cardiac rehab • Number of patients enrolled in cardiac rehab

  7. Results • 1845 patients were discharged from Duke Hospital over the 10 months of the study who met CR eligibility. • 980 prior to CPOE prompt • 865 after CPOE prompt

  8. Fixing Duke CR referrals by admission CPOE prompt Patients Eligible for Cardiac Rehab 1-year before New Referral System (n = 2584) Patients Eligible for Cardiac Rehab 1-year after New Referral System (n = 2626) 10% not referred Only 34% referred 66% not referred to cardiac rehab 90% referred to Cardiac rehab Patel et al. (in press)

  9. Referral to CR is only half the problem  Enrollment and Completion of the CR program is the real goal

  10. Referral to CR is only half the problem  Enrollment and Completion of the CR program is the real goal 172/471 = only 36.5% of those referred then enrolled

  11. Enrollment Overcoming Patient Barriers

  12. October 2009-March 2010 average monthly CR-eligible patients at Duke Almost half the patients leave the hospital before a CR team member could see them Kelechi Ndubuizu, DMS3

  13. Barriers to better enrollment Kelechi Ndubuizu, DMS3

  14. Enhancing Outcomes Tracking

  15. Outcomes in a CR Program

  16. Summary Evidence for Benefits of CR

  17. Summary Evidence for Benefits of CR

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