Is 70% Achievable? Hospital-Level Variation in Rates of Cardiac Rehabilitation Use Among Medicare Beneficiaries

Quinn R. Pack, Taylor Keys, Aruna Priya, Penelope S. Pekow, Steven J. Keteyian, Michael P. Thompson, Thomas D'Aunno, Peter K. Lindenauer, Tara Lagu

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Despite national goals to enroll 70% of cardiac rehabilitation (CR)-eligible patients, enrollment remains low. Objectives: The purpose of this study was to evaluate how the treating hospital influences CR enrollment nationally. Methods: We included Fee-for-Service Medicare beneficiaries aged ≥66 years who were hospitalized for acute myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or heart valve repair/replacement. We examined: 1) a risk-standardized model to assess comparative hospital rates; 2) a linear regression model to identify hospital factors associated with rates of risk-standardized CR; and 3) a hierarchical generalized linear model to calculate the hospital median OR. Results: At 3,420 hospitals, we identified 264,970 eligible patients. A minority of hospitals (n = 1,446; 38%) performed cardiac surgery, but these hospitals cared for the majority (n = 242,875; 92%) of all eligible patients. Subsequent analyses were limited to these hospitals. The median risk-standardized CR enrollment rate was low (22%) and varied 10-fold across hospitals (10th, 90th percentile: 3%, 42%). Factors associated with higher hospital performance were Midwest location, higher number of hospital beds, directly affiliated CR program, and <1 mile distance between the hospital and closest CR facility. The national hospital median OR was 2.1. Conclusions: The treating hospital plays a key role in facilitating CR enrollment after discharge. Fewer than 1% of U.S. hospitals achieved a risk-standardized CR enrollment rate of >70%. Hospitals with cardiac surgery capability care for more than 90% of all CR-eligible patients and may be a logical place to focus improvement efforts.

Original languageEnglish (US)
Article number101275
JournalJACC: Advances
Volume3
Issue number11
DOIs
StatePublished - Nov 2024

Keywords

  • Medicare
  • cardiac rehabilitation
  • quality of care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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