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
Incorporate Referral to CR into Hospital Standardized Processes of Care for Eligible Patients
Change Idea:
Include referral to CR in order sets for appropriate patients; incorporate into EHR as appropriate
Tools & Resources:
- Henry Ford Health System—EMR Discharge Order Set, “Opt Out” Cardiac Rehabilitation Referral Screenshot [PDF-56KB]
- Montoye CK, et al., 2005.20 Template AMI Orders [PDF-1.5M] (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/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-282KB]
- How to Find Cardiac Rehabilitation Programs in the United States Using the CDC Interactive Atlas of Heart Disease and Stroke [PDF-676KB]
- AACVPR—Program Directory
- Massachusetts General Hospital—Fax Cover Sheet for External Cardiac Rehabilitation Referrals [Word-33KB]
- Massachusetts General Hospital—Cardiac Rehabilitation Referral Form [PDF-441KB]
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-280KB]
- Massachusetts General Hospital—Fax Cover Sheet for Cardiac Rehabilitation Patient Self-Referral [Word-63KB]
- Massachusetts General Hospital—Cardiac Rehabilitation Physician Referral for Patients who Self-Refer [PDF-9KB]
Standardize the CR Referral Process
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-280KB]
- Emory Healthcare—Cardiac Rehabilitation Electronic Referral Process and Communication Tool Presentation [PDF-1.5MB]
- Case Study: Penn Medicine—A Systematic Approach to Increasing Cardiac Rehabilitation Referrals [PDF-619KB]
- Penn Medicine—Cardiac ICU CR Referral Process [PDF-189KB]
- Lake Regional Health System—Cardiopulmonary Rehabilitation Referral Process Map [PDF-197KB]
- Lake Regional Health System—Physician Referral/Order Policy [PDF-255KB]
- Lake Regional Health System—Admission Guidelines, Cardio Pulmonary Rehab [PDF-123KB]
- Genesis HealthCare System—Phase II/III/IV Admission, Orientation, and Discharge Policy and Procedure [PDF-129KB]
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-370KB]
Change Idea:
Implement standardized paper/faxed referral to CR from an inpatient setting
Tools & Resources:
- Massachusetts General Hospital—Cardiac Rehabilitation Referral Form [PDF-441KB]
- Beth Israel Deaconess Hospital, Milton—Cardiac Rehabilitation Physician Referral Form [PDF-193KB]
- 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 and Communication Tool Presentation [PDF-1.5MB] (slides 3–8)
- Massachusetts General Hospital—EHR Automatic Referral to CR Screenshots [PDF-232KB]
- Henry Ford Health System—EMR-based Cardiac Rehabilitation Referral as an “Opt Out” Process in Diagnosis-Related Order Sets [PDF-56KB]
- Ali-Faisal SF, et al., 2016.22 Figure 1: eReferral Screenshot from Electronic Discharge Summary [PDF-1MB]
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-164KB]
Use Data to Drive Improvement in Referrals to CR
Change Idea:
Determine inpatient referral metrics to CR
Tools & Resources:
- Thomas RJ, et al., 2018.19 Performance Measure 1. Cardiac Rehabilitation Patient Referral From an Inpatient Setting (pp. 12–13)
- Thomas RJ, et al., 2018.19 Performance Measure 2. Exercise Training Referral for HFrEF From an Inpatient Setting (p. 14)
- AACVPR—Introduction to Cardiac Rehabilitation Performance Measures [PDF-316KB]
- AACVPR—Example Application of Cardiac Rehabilitation Performance Measures [PDF-160KB]
Change Idea:
Determine outpatient referral metrics to CR
Tools & Resources:
- Thomas RJ, et al., 2018.19 Performance Measure 3. Cardiac Rehabilitation Patient Referral From an Outpatient Setting (pp. 15–16)
- Thomas RJ, et al., 2018.19 Performance Measure 4. Exercise Training Referral for HFrEF From an Outpatient Setting (p. 17)
- AACVPR—Introduction to Cardiac Rehabilitation Performance Measures [PDF-316KB]
- AACVPR—Example Application of Cardiac Rehabilitation Performance Measures [PDF-160KB]
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-364KB]
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-729K]
- Lake Regional Health System—Percent of Patients Referred to CR by Physician [PPT-431KB]
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-288KB]
- Emory Healthcare—Cardiac Rehabilitation Electronic Referral Process and Communication Tool Presentation [PDF-1.5MB] (slides 9–11)
- AACVPR—Inpatient Tracking Form [Excel-53KB]
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-729KB]
- Penn Medicine—Dashboard of Patients with Qualifying Diagnoses to Track Who Was Eligible, Ineligible, Referred, and Declined Services [PDF-288KB]
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:
