Focus Area: Enrollment and Participation

Change concept, change idea, tools and resources.

Enrollment and participation strategies are approaches that health systems can use to encourage enrollment and participation in cardiac rehabilitation (CR). These include various modes of patient education and engagement and different ways in which CR programs can be modified to better accommodate patient needs and preferences.

Note: Change concepts are general notions that are useful in the development of more specific ideas for changes that lead to improvement. Change ideas are actionable, specific ideas or strategies for changing a process. Each change idea lists evidence- or practice-based tools and resources that can be adapted by or adopted in a health care setting to improve CR utilization.

Enrollment and Participation: Change Concepts

Change Idea:
Deploy an inpatient “liaison” to help educate, refer, schedule, and enroll eligible patients in outpatient CR

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Inpatient Liaison for Outpatient Cardiac Rehabilitation [PDF – 291K]
Case Study: Memorial Hospital of Carbondale—Cardiac Rehabilitation: Phase I [PDF – 753K]
Memorial Hospital of Carbondale—“Welcome to Phase I Cardiac Rehab” Binder [PDF – 558K]
Lake Regional Health System—Cardiopulmonary Rehabilitation Center: Phase 1 Program Guideline for Inpatient Educators [PDF – 655K]

Change Idea:
Use videos to describe your CR program and the impact of CR on health outcomes before hospital discharge or at the beginning of outpatient CR

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Use of Video [PDF – 552K]
Mary’s Hospital—Cardiac Rehab Program
Cardiac Rehab at Johns Hopkins Medicine
Home Health Quality Improvement—Cardiac Rehab YouTube playlist

Change Idea:
Provide patient education materials that convey CR benefits

Tools & Resources:

Mayo Clinic—Cardiovascular Rehabilitation Program [PDF – 680K]
American Heart Association—Cardiac Rehab
AACVPR—2016 Cardiac Rehabilitation Fact Sheet: Cardiac Rehabilitation—An Individualized Supervised Program for You [PDF – 400K]
American College of Cardiology—CardioSmart: What Is Cardiac Rehabilitation? infographic [PDF – 11.6M]

Change Idea:
Before hospital discharge, establish an early (within 12 days of discharge) outpatient appointment

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Reducing the Delay Between Hospital Discharge and Enrollment into Cardiac Rehabilitation [PDF – 343K]
Baystate Medical Center—Cardiovascular Rehabilitation and Wellness: Admission, Orders and Enrollment Policy and Procedure [PDF – 225K]

Change Idea:
Determine CR enrollment or participation metrics

Tools & Resources:

Thomas RJ, et al., 2018.¹⁹Performance Measure 5A. Enrollment (Claims-Based) (p. 18)
Thomas RJ, et al., 2018.¹⁹Performance Measure 5B. Enrollment (Medical Records and/or Databases/Registries) (p. 19)
Thomas RJ, et al., 2018.¹⁹Quality Measure 1. Time to Enrollment (p. 20)

Change Idea:
Regularly provide a dashboard with enrollment or participation metrics, goals, and performance

Tools & Resources:

Lake Regional Health System—CR Enrollment Rate [PPT – 434K]
Lake Regional Health System—Enrolled Participants by Diagnosis [PPT – 430K]
AACVPR—Sample Spreadsheet to Collect Enrollment Rates of a CR Program [PDF – 111K]

Change Idea:
Assist patients with high out-of-pocket costs or economic burden to navigate payment options

Tools & Resources:

Case Study: Christiana Care Health System—Reducing Cost-Sharing Barriers for CR Services with Creative Options [PDF – 270K]
Lake Regional Health System—Cardiopulmonary Rehabilitation Referral Process Map [PDF – 197K]

Change Idea:
Establish a philanthropic fund to partly underwrite CR costs for patients with high co-payments or without insurance

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Establish a Philanthropic Fund: Spotlight on Henry Ford Health System [PDF – 311K]

Change Idea:
Incorporate group orientations

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Cardiac Rehabilitation Pre-Enrollment Group Screening [PDF – 407K]
Case Study: Genesis HealthCare System—Group Orientation [PDF – 294K]
Genesis HealthCare System—Phase II/III/IV Admission, Orientation, and Discharge Policy and Procedure [PDF – 130K]
Genesis HealthCare System—Genesis Heart & Vascular Rehabilitation Group Orientation Process Flowsheet [PDF – 395K]
Genesis HealthCare System—Heart & Vascular Rehab Group Orientations PowerPoint for CR Program Teams [PDF – 1.2M]
Genesis HealthCare System—Welcome to Heart & Vascular and Pulmonary Rehabilitation PowerPoint for patients [PDF – 1.2M]
Case Study: Rochester Regional—Group Orientation [PDF – 290K]
Case Study: University of Alabama at Birmingham—Increase Enrollment and Session Adherence [PDF – 290K]

Change Idea:
Offer accelerated CR programs

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Accelerated Use of Cardiopulmonary Rehabilitation [PDF – 294K]

Change Idea:
Modify program structure and hours of operation to match patient preferences, to accommodate more patients

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Cardiac Rehabilitation Timeline and Program Structure: Spotlight on Mount Carmel Health System [PDF – 555K]

Change Idea:
Shift from class structure to open-gym model

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Matching Capacity to Demand: Open Gym [PDF – 291K]
Case Study: Southwest Florida Heart Group—Open Gym Model [PDF – 295K]
Case Study: Mount Carmel Health System—Cardiac Rehab Open Gym [PDF – 173K]

Change Idea:
Develop hybrid model of home-based and facility-based program that includes key components of CR

Tools & Resources:

Change Idea:
Match frequency and/or use of ECG telemetry monitoring to clinical need

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—ECG Monitoring Based on Clinical Need [PDF – 306K]
Case Study: Henry Ford Health System—Electrocardiography Monitoring Based on Clinical Need [PDF – 143K]

Change Idea:
Improve operational efficiency with BP management

Tools & Resources:

Case Study: NYU Langone Health—A Value-based Management Approach to Efficient Blood Pressure Monitoring During Outpatient Cardiac Rehabilitation (with BP Flowchart) [PDF – 305K]

Change Idea:
Engage referring clinicians by providing letters that highlight non-enrolled patients for clinician follow-up

Tools & Resources:

Case Study: Christiana Care Health System—Use Clinician Follow-up to Bolster Enrollment [PDF – 171K]
AACVPR—Sample of Cardiac Rehabilitation/Secondary Prevention Non-Enrollment Letter Sent to Cardiologist [Word – 87K]

Change Idea:
Engage referring clinicians by providing progress reports and completion of program outcomes

Tools & Resources:

AACVPR Cardiac Rehabilitation Enrollment Strategy—Cardiac Rehabilitation Patient Progress Report [PDF – 287K]
AACVPR Cardiac Rehabilitation Enrollment Strategy—Cardiac Rehabilitation Outcome Report Sheet [PDF – 286K]

Bold font indicates CR programs that contributed content.

Note: References for citations on this page can be found under Additional Resources and References.

Additional Focus Areas

Learn more about the other Cardiac Rehabilitation Change Package (CRCP) focus areas:

Page last reviewed: October 24, 2019

Content source: Division for Heart Disease and Stroke Prevention