PDF(Pubmed)
Abstract：
Introduction Cardiac rehabilitation (CR) is an underutilized resource in patients with ischemic heart disease, despite being a Class IA recommendation. In this study, a multidisciplinary quality improvement (QI) team aimed to improve CR referrals by standardizing the ordering process at our hospital system. Method By using a collaborative approach involving the electronic medical record (EMR), medical provider education, and hospital protocols, our two-hospital healthcare system was able to successfully identify barriers to CR referral rates and implement interventions for these barriers. All physicians and medical providers, including ancillary staff, were educated on the EMR order sets to improve compliance by using automated order sets in the EMR. The CR referral order in the EMR included a statement regarding the application of evidence-based medicine, and a computerized provider order entry was included as a reminder to the ordering provider. The use of EMR was monitored monthly by the QI committee. Chi-square test and odds ratios were obtained for statistical analysis. Results Through provider-EMR education and patient education on discharge, CR referral rates significantly improved from 51.2 to 87.1% (p = 0.0001) in a 12-month period. The study included 1,499 patients in total. The improvement was statistically significant regardless of patient gender, race, or insurance coverage. Additionally, subgroup analysis in this study found that prior to standardization of the ordering process, African American patients were significantly less likely to be referred to CR compared to Caucasian patients. (51.2% vs. 41.0%, p=0.01). There was no statistically significant difference in the likelihood of CR referral between Caucasian and African American patients following the intervention (84.0% vs. 78.0%, p = 0.166). Conclusion This study shows that CR is an underutilized resource and that effective QI initiatives may not only increase CR referral rates but also close the gap between racial inequities in referral rates. Future research with multi-center randomized control trials is needed to further enhance its external generalizability to other institutions.
摘要：
介绍心脏康复（CR）是缺血性心脏病患者未充分利用的资源，尽管是IA类推荐。在这项研究中,一个多学科质量改进(QI)团队旨在通过规范我们医院系统的订购流程来改善CR转诊.方法采用涉及电子病历(EMR)的协作方法，医疗提供者教育，和医院协议，我们的两所医院医疗系统能够成功识别CR转诊率的障碍,并针对这些障碍实施干预措施.所有医生和医疗提供者，包括辅助人员，通过在EMR中使用自动订单集来教育EMR订单集，以提高合规性。EMR中的CR转诊命令包括关于循证医学应用的声明，并包括计算机化的提供商订单条目，以提醒订购提供商。QI委员会每月监测EMR的使用情况。采用卡方检验和比值比进行统计分析。结果通过提供者EMR教育和患者出院教育，CR转诊率在12个月内从51.2％显着提高到87.1％（p=0.0001）。该研究共包括1,499名患者。无论患者性别如何，改善均具有统计学意义，种族,或保险范围。此外,本研究的亚组分析发现，在订购过程标准化之前，与白种人患者相比，非裔美国人患者被转诊至CR的可能性明显较小。（51.2%与41.0%,p=0.01)。干预后，白种人和非裔美国人患者CR转诊的可能性没有统计学上的显着差异（84.0％vs.78.0%,p=0.166）。结论这项研究表明，CR是一种未充分利用的资源，有效的QI计划不仅可以提高CR转诊率，而且可以缩小转诊率种族不平等之间的差距。未来需要进行多中心随机对照试验的研究，以进一步提高其对其他机构的外部普适性。
