Abstract 1479: The Effects of Computerized Referral and In-Hospital Visit on Local Compared to Statewide Cardiac Rehabilitation Enrollment

Participation in cardiac rehabilitation (CR) remains low, and strategies to increase referral and participation are needed. In July 2008, a prompt for referral to CR was added to the computerized physician order entry (CPOE) system at Duke Hospital as part of a hospital admission order set. This intervention increased referrals and surpassed the ability of CR staff to visit all CR-eligible patients while in the hospital. Two approaches were taken: an in-hospital visit for patients who live within a tri-county area around Duke, and a mailed referral to the nearest CR program for patients who live outside the tri-county area. We examined the effect of our process improvement changes on local CR referral and enrollment versus statewide trends. Methods: CR programs in the state of NC were polled regarding their enrollment over the 5 months before and 5 months after process improvement changes were made. Enrollment means and ranges were calculated for all CR programs before and after the CPOE and personal referral intervention. The programs were divided into those that were in the tri-county area surrounding Duke, and those that were outside the tri-county area. Results: There were 1845 patients discharged from Duke Hospital over the 10 months of this study who met CR eligibility (980 before and 865 after CPOE intervention respectively). Of these, 38% were referred for CR before, and 82% were referred for CR after the CPOE intervention. There were 28 CR programs that responded to the poll. Conclusion: The combination of CPOE and in-hospital CR referral led to an increase in enrollment in all 4 tri-county CR programs. These process improvements while in the hospital tripled enrollment in Duke CR. In contrast, there is cause for concern about decreased enrollment in 67% of CR programs outside the tri-county area, perhaps reflecting increased financial barriers such as increased co-payments and travel costs.