Focus Area: Referrals

Referrals strategies are approaches aimed at bolstering cardiac rehabilitation (CR) referral. These include using standardized processes, electronic referrals, and health system data to drive improvement.
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.
Referrals: Change Concepts
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 icon[PDF – 56K]external icon
- Montoye CK, et al., 2005.20 Template AMI Orders pdf icon[PDF – 321K]external icon (pp. 24B–25B)
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/Instructionsexternal icon (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 icon[PDF – 321K]external icon (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 icon[PDF – 282K]external icon
- How to Find Cardiac Rehabilitation Programs in the United States Using the CDC Interactive Atlas of Heart Disease and Stroke pdf icon[PDF – 676K]external icon
- AACVPR—Program Directoryexternal icon
- Massachusetts General Hospital—MGH Fax Cover Sheet for External Cardiac Rehabilitation Referrals word icon[Word – 33K]external icon
- Massachusetts General Hospital—MGH Cardiac Rehabilitation Referral Form pdf icon[PDF – 441K]external icon
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 icon[PDF – 280K]external icon
- Massachusetts General Hospital—MGH Fax Cover Sheet for Cardiac Rehabilitation Patient Self-Referral word icon[Word – 63K]external icon
- Massachusetts General Hospital—MGH Cardiac Rehabilitation Physician Referral for Patients who Self-Refer pdf icon[PDF – 9K]external icon
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 icon[PDF – 280K]external icon
- Emory Healthcare—Cardiac Rehabilitation Electronic Referral Process Communication Tool pdf icon[PDF – 1.5M]external icon
- Case Study:Penn Medicine—A Systematic Approach to Increasing Cardiac Rehabilitation Referrals pdf icon[PDF – 619K]external icon
- Penn Medicine—Cardiac Intensive Care Unit CR Referral Process pdf icon[PDF – 189K]external icon
- Lake Regional Health System—Cardiopulmonary Rehabilitation Referral Process Map pdf icon[PDF – 197K]external icon
- Lake Regional Health System—Physician Referral/Order Policy pdf icon[PDF – 255K]external icon
- Lake Regional Health System—Admission Guidelines, Cardiopulmonary Rehab pdf icon[PDF – 123K]external icon
- Genesis HealthCare System—Phase II/III/IV Admission, Orientation, and Discharge Policy and Procedure pdf icon[PDF – 129K]external icon
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 Healthpdf icon[PDF – 370K]external icon
Change Idea:
Implement standardized paper/faxed referral to CR from an inpatient setting
Tools & Resources:
- Massachusetts General Hospital—Cardiac Rehabilitation Referral Form pdf icon[PDF – 441K]external icon
- Beth Israel Deaconess Hospital, Milton—Cardiac Rehabilitation Physician Referral Form pdf icon[PDF – 193K]external icon
- Thomas RJ, et al., 2007.21 Referral Order to an Early Outpatient Cardiac Rehabilitation/Secondary Prevention Program: From an Inpatient Settingexternal icon (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 Settingexternal icon (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 icon[PDF – 1.5M]external icon(slides 3–8)
- Massachusetts General Hospital—EHR Automatic Referral to CR screenshots pdf icon[PDF – 232K]external icon
- Henry Ford Health System—EMR-based Cardiac Rehabilitation Referral as an “Opt Out” Process in Diagnosis-Related Order Sets pdf icon[PDF – 56K]external icon
- 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 icon[PDF – 1M]external icon
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 icon[PDF – 164K]external icon
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 Settingexternal icon (pp. 12–13)
- Thomas RJ, et al., 2018.19 Performance Measure 2. Exercise Training Referral for HFrEF from Inpatient Settingexternal icon (p. 14)
- AACVPR—Introduction to Cardiac Rehabilitation Performance Measures pdf icon[PDF – 316K]external icon
- AACVPR—Example Application of Cardiac Rehabilitation Performance Measures pdf icon[PDF – 160K]external icon
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 Settingexternal icon (pp. 15–16)
- Thomas RJ, et al., 2018.19 Performance Measure 4. Exercise Training Referral for HFrEF from Outpatient Settingexternal icon (p. 17)
- AACVPR—Introduction to Cardiac Rehabilitation Performance Measures pdf icon[PDF – 316K]external icon
- AACVPR—Example Application of Cardiac Rehabilitation Performance Measures pdf icon[PDF – 160K]external icon
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 icon[PDF – 364K]external icon
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 Datapdf icon[PDF – 578K]external icon
- Lake Regional Health System—Percent of Patients Referred to CR by Physician ppt icon[PPT – 431K]external icon
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 icon[PDF – 288K]external icon
- Emory Healthcare—Cardiac Rehabilitation Electronic Referral Process Communication Tool pdf icon[PDF – 1.5M]external icon(slides 9–11)
- AACVPR—Inpatient Tracking Form excel icon[Excel – 53K]external icon
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 Datapdf icon[PDF – 578K]external icon
- Penn Medicine—Dashboard of Patients with Qualifying Diagnoses to Track Who Was Eligible, Ineligible, Referred, and Declined Services pdf icon[PDF – 288K]external icon
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: