TY - JOUR
T1 - Is 70% Achievable? Hospital-Level Variation in Rates of Cardiac Rehabilitation Use Among Medicare Beneficiaries
AU - Pack, Quinn R.
AU - Keys, Taylor
AU - Priya, Aruna
AU - Pekow, Penelope S.
AU - Keteyian, Steven J.
AU - Thompson, Michael P.
AU - D'Aunno, Thomas
AU - Lindenauer, Peter K.
AU - Lagu, Tara
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/11
Y1 - 2024/11
N2 - 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.
AB - 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.
KW - Medicare
KW - cardiac rehabilitation
KW - quality of care
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U2 - 10.1016/j.jacadv.2024.101275
DO - 10.1016/j.jacadv.2024.101275
M3 - Article
AN - SCOPUS:85209575496
SN - 2772-963X
VL - 3
JO - JACC: Advances
JF - JACC: Advances
IS - 11
M1 - 101275
ER -