Focus Area: Referrals

Change Idea:
Include referral to CR in order sets for appropriate patients; incorporate into EHR as appropriate

Tools & Resources:

• Henry Ford Health System—EMR-based Cardiac Rehabilitation Referral as an “Opt Out” Process in Diagnosis-Related Order Sets screenshot [PDF – 56K]

Change Idea: 
Include referral to CR in discharge checklists for appropriate patients; incorporate into EHR as appropriate

Tools & Resources:

• Thomas RJ, et al., 2007.²¹ Multidisciplinary Cardiac Discharge Checklist/Instructions (p. 1409)

Change Idea: 
Include referral to CR in appropriate patient discharge forms; incorporate into EHR as appropriate

Tools & Resources:

• Montoye CK, et al., 2005.²⁰ Heart Attack Discharge Form [PDF – 321K] (p. 29B)

Change Idea:
Develop a standard process for informing an external CR program of a referred patient

Tools & Resources:

• Case Study: Massachusetts General Hospital—Referral of Patient to External Cardiac Rehabilitation Program [PDF – 282K]
• How to Find Cardiac Rehabilitation Programs in the United States Using the CDC Interactive Atlas of Heart Disease and Stroke [PDF – 676K]
• AACVPR—Resources for Professionals
• Massachusetts General Hospital—MGH Fax Cover Sheet for External Cardiac Rehabilitation Referrals [Word – 33K]
• Massachusetts General Hospital—MGH Cardiac Rehabilitation Referral Form [PDF – 441K]

Change Idea:
Develop a standard process for eligible patients to self-refer to CR

Tools & Resources:

• Case Study: Massachusetts General Hospital—Self-Referral of Patient to a Cardiac Rehabilitation Program [PDF – 280K]
• Massachusetts General Hospital—MGH Fax Cover Sheet for Cardiac Rehabilitation Patient Self-Referral [Word – 63K]
• Massachusetts General Hospital—MGH Cardiac Rehabilitation Physician Referral for Patients who Self-Refer [PDF – 9K]

Change Idea:
Develop and communicate a standardized referral process or policy for patients

Tools & Resources:

• Case Study:Emory Healthcare—Multidisciplinary-Developed Cardiac Rehabilitation Referral [PDF – 280K]
• Emory Healthcare—Cardiac Rehabilitation Electronic Referral Process Communication Tool [PDF – 1.5M]
• Case Study:Penn Medicine—A Systematic Approach to Increasing Cardiac Rehabilitation Referrals [PDF – 619K]
• Penn Medicine—Cardiac Intensive Care Unit CR Referral Process [PDF – 189K]
• Lake Regional Health System—Cardiopulmonary Rehabilitation Referral Process Map [PDF – 197K]
• Lake Regional Health System—Physician Referral/Order Policy [PDF – 255K]
• Lake Regional Health System—Admission Guidelines, Cardiopulmonary Rehab [PDF – 123K]
• Genesis HealthCare System—Phase II/III/IV Admission, Orientation, and Discharge Policy and Procedure [PDF – 129K]

Change Idea: 
Develop and communicate a standardized outpatient CR referral process or policy for patients discharged to inpatient acute or subacute rehabilitation or to homecare services

Tools & Resources:

• AACVPR Cardiac Rehabilitation Referral Strategy—Bridging the Rehabilitation Care Continuum: Spotlight on NYU Langone Health[PDF – 370K]

Change Idea:
Implement standardized paper/faxed referral to CR from an inpatient setting

Tools & Resources:

• Massachusetts General Hospital—Cardiac Rehabilitation Referral Form [PDF – 441K]
• Beth Israel Deaconess Hospital, Milton—Cardiac Rehabilitation Physician Referral Form [PDF – 193K]
• Thomas RJ, et al., 2007.²¹ Referral Order to an Early Outpatient Cardiac Rehabilitation/Secondary Prevention Program: From an Inpatient Setting (p. 1407)

Change Idea:
Implement standardized paper/faxed referrals to CR from an outpatient setting

Tools & Resources:

• Thomas RJ, et al., 2007.²¹ Referral Order to an Early Outpatient Cardiac Rehabilitation/Secondary Prevention Program: From an Outpatient Setting (p. 1408)

Change Idea:
Use inpatient EHR tools to automate referrals to CR for all eligible patients, including default or “opt-out” orders for patients with qualifying diagnoses

Tools & Resources:

• Emory Healthcare—Cardiac Rehabilitation Electronic Referral Process Communication Tool [PDF – 1.5M](slides 3–8)
• Massachusetts General Hospital—EHR Automatic Referral to CR screenshots [PDF – 232K]
• Henry Ford Health System—EMR-based Cardiac Rehabilitation Referral as an “Opt Out” Process in Diagnosis-Related Order Sets [PDF – 56K]
• Ali-Faisal SF, et al., 2016.²² Figure 1 from Cardiac Rehabilitation Referral and Enrolment Across an Academic Health Sciences Centre with eReferral and Peer Navigation: A Randomised Controlled Pilot Trial [PDF – 1M]

Change Idea:
Use outpatient EHR tools to automate referrals for patients with qualifying diagnoses who have not participated in CR

Tools & Resources:

• Massachusetts General Hospital—EHR Outpatient Referral to CR screenshot [PDF – 164K]

Change Idea:
Determine inpatient referral metrics to CR

Tools & Resources:

• Thomas RJ, et al., 2018.¹⁹ Performance Measure 1. Cardiac Rehabilitation Patient Referral from Inpatient Setting (pp. 12–13)
• Thomas RJ, et al., 2018.¹⁹ Performance Measure 2. Exercise Training Referral for HFrEF from Inpatient Setting (p. 14)
• AACVPR—Introduction to Cardiac Rehabilitation Performance Measures [PDF – 316K]
• AACVPR—Example Application of Cardiac Rehabilitation Performance Measures [PDF – 160K]

Change Idea: 
Determine outpatient referral metrics to CR

Tools & Resources:

• Thomas RJ, et al., 2018.¹⁹ Performance Measure 3. Cardiac Rehabilitation Patient Referral from Outpatient Setting (pp. 15–16)
• Thomas RJ, et al., 2018.¹⁹ Performance Measure 4. Exercise Training Referral for HFrEF from Outpatient Setting (p. 17)
• AACVPR—Introduction to Cardiac Rehabilitation Performance Measures [PDF – 316K]
• AACVPR—Example Application of Cardiac Rehabilitation Performance Measures [PDF – 160K]

Change Idea:
Use CR referral performance measures in a quality improvement system

Tools & Resources:

• AACVPR Cardiac Rehabilitation Systems Change Strategy—Using Cardiac Rehabilitation Referral Performance Measures in a Quality Improvement System [PDF – 364K]

Change Idea:
Regularly provide a dashboard with CR referral metrics, goals, and performance

Tools & Resources:

• AACVPR Cardiac Rehabilitation Referral Strategy—Using Clinical Data Registries to Access Cardiac Rehabilitation Referral Data[PDF – 578K]
• Lake Regional Health System—Percent of Patients Referred to CR by Physician [PPT – 431K]

Change Idea:
Implement a CR Registry to identify, track, and manage patients who are referred to a CR program

Tools & Resources:

• Penn Medicine—Dashboard of Patients with Qualifying Diagnoses to Track Who Was Eligible, Ineligible, Referred, and Declined Services [PDF – 288K]
• Emory Healthcare—Cardiac Rehabilitation Electronic Referral Process Communication Tool [PDF – 1.5M](slides 9–11)
• AACVPR—Inpatient Tracking Form [Excel – 53K]

Change Idea:
Identify patients who had a cardiac event without a referral to a CR program

Tools & Resources:

• AACVPR Cardiac Rehabilitation Referral Strategy—Using Clinical Data Registries to Access Cardiac Rehabilitation Referral Data[PDF – 578K]
• Penn Medicine—Dashboard of Patients with Qualifying Diagnoses to Track Who Was Eligible, Ineligible, Referred, and Declined Services [PDF – 288K]