Currently, disparities exist in cardiac rehabilitation (CR) use as services are underutilized by older adults, women, and minorities, especially those who use post-hospital services. Older adults are a group that we know can benefit from formal CR;yet they do not use it. Formal CR must be used by older adults so that they can receive the documented benefits. The proposed study is significant because it will describe the continuum of cardiac care, expand our knowledge of why older adults do not receive out-patient CR services beyond the known factors of age, gender, race, and location, and will examine the effect of clinical factors not traditionally considered. These clinical factors include disability and illness burden (i.e., illness severity, comorbidity, complications, treatment, and rehabilitation contraindications). Many of these clinical variables can be modified and thus we can improve disability so that it no longer acts as a barrier to older adults participation in CR affording them the benefits of participation. The identification of the specific components of illness burden will provide insight into the unique needs of older adults after a cardiac event. In addition, time to CR service use is not known and may vary for reasons related to disability and illness burden. Identifying time to CR service use may reinforce the need to implement a care path that reinforces a smooth continuum of care that will impact the high rehospitalization rates. The clinical application of the information gained from this study will assist in the development of targeted interventions to increase formal CR use and to integrate CR principles into post-hospital services, to better meet the unique needs of older adults. If the present study identifies that disability is a factor in older MI patients'under-utilization of out-patient CR (and not just age, gender, and race), then earlier interventions to reduce disability can be implemented. Earlier interventions based on CR principles can be integrated into post-hospital care to optimize recovery for older adults. This study is innovative in that it challenges the current model of CR developed in the 1970s to prepare middle aged males to return to work following a MI. Despite the changing demographics of cardiac patients (older, sicker, and more women), the current CR model and reimbursement structure have not changed in 35 years. Medicare still reimburses only for formal out-patient CR. If findings from the present study indicate that disability, illness severity, comorbidity and complications are high and rehabilitation contraindications low in patients using post-hospital services, changes to the current CR service reimbursement structure can be considered to provide CR care principles during hospitalization and post-hospital care in addition to those offered in formal out-patient CR. This type of change will assure that a continuum of CR services is delivered as is recommended by the AACVPR. The proposed study will provide initial evidence of the need to consider changes to this policy to include MI patients.
Disability, Illness Burden, and Transitions of Care to CR Reduction of disability is important to older adults as physical function is integral to independence in activities of daily living, involvement in social activities, and quantity of quality life years. Fifty percent of older adults after an MI use traditional post-hospital services and 19% are rehospitalized in the first 30 days. Post-hospital services do not include cardiac rehabilitation (CR) principles for patients post-MI. CR principles are delivered in the outpatient setting 4 to 6 weeks after MI for those who enroll in this service. Understanding relationships among disability, illness burden, use of CR, and time to CR use by older persons after an MI in those using post-hospital services when compared to those who do not use post-hospital services will help us to recognize and overcome barriers to the continuum of cardiac care and frequent rehospitalizations.
| Zullo, Melissa D; Gathright, Emily C; Dolansky, Mary A et al. (2017) Influence of Depression on Utilization of Cardiac Rehabilitation Postmyocardial Infarction: A STUDY OF 158 991 MEDICARE BENEFICIARIES. J Cardiopulm Rehabil Prev 37:22-29 |
