Supplementary Materials
Participation Rates, Process Monitoring, and Quality Improvement Among United States Cardiac Rehabilitation Programs: A National Survey
Authors:
Quinn R. Pack, MD; Ray W. Squires, PhD; Francisco Lopez-Jimenez, MD, MSc; Steven W. Lichtman, EdD; Juan P. Rodriguez-Escudero, MD; Peter K Lindenauer, MD MSc;
Randal J. Thomas, MD, MS
Cardiac Rehabilitation Participation Study: A National Survey
Introduction
1. Which best describes you?
Program director
Program supervisor/manager
Program staff member
Medical director Program Characteristics
2. In what state is your phase II outpatient cardiac rehabilitation program located?
__________________ (U.S. State)
3. About how many people live in the town/city/metropolis in which your phase II outpatient cardiac rehabilitation program is located?
Less than 50,000 people
50,000 to 99, 999 people
100,000 to 249,999 people
250,000 to 499,999 people
500,000 to 999,999 people
1 million people or more
8. How many total staff positions, as measured by full time equivalents (FTE’s), are employed at your cardiac rehabilitation program?
__________________________ (number of FTE’s.)
4. Approximately what percentage of patients in your phase II outpatient cardiac
rehabilitation program are referred directly from an inpatient hospital setting (as opposed to a office/clinic setting)?
0-20%
21-40%
41-60%
61-80%
80-100%
Unsure
5. What best describes your phase II outpatient cardiac rehabilitation program’s location relative to your principal referring hospital?
We are in the same building/complex as our principal referring hospital
We are on the same campus/neighborhood as our principal referring hospital
We are within 5-10 minutes of travel time from our principal referring hospital
We are further than 10 minutes of travel time from our principal referring hospital
6. What best describes your phase II outpatient cardiac rehabilitation program’s location relative to your principal referring outpatient office/clinic?
We are in the same building/complex as our principal referring office/clinic
We are on the same campus/neighborhood as our principal referring office/clinic
We are within 5-10 minutes of travel time from our principal referring office/clinic
We are further than 10 minutes of travel time from our principal referring office/clinic
7. Which of the following are features of your cardiac rehabilitation program? (Check all that apply)
Phase I/in-hospital program
Phase II/outpatient program
Phase III/IV long-term maintenance program
Participation in a coordinated network of cardiac rehabilitation centers.
Electronic medical record
Current program certification from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)
Academic medical center or affiliation (university or medical school affiliation)
Ongoing clinical research projects that are published in medical journals and/or presented at medical conferences, on issues related to the field of cardiac rehabilitation.
Enrollment
8. For hospitalized patients with a new qualifying event for cardiac rehabilitation, what is the estimated average time interval between a patient’s hospital discharge and their first phase II outpatient cardiac rehabilitation session (either orientation or exercise) in your program? Please estimate for all patients regardless of diagnosis (medical or surgical).
1-2 weeks
3-4 weeks
5-6 weeks
7-8 weeks
9 weeks or more
Unsure
9. What percentage of the time does your program telephone or in other ways personally contact patients (in the 2-3 days prior) to remind them of their first appointment (usually orientation) in cardiac rehabilitation?
0-20%
21-40%
41-60%
61-80%
80-100%
Unsure
10. Which of the following programmatic features are available at your outpatient rehabilitation program? (Check all that apply)
Gender-tailored programs (for example, a women-only session)
Age-tailored programs for the elderly/frail (for example, a session for older patients only, age>65)
Spouse participation (for example, in exercise sessions or educational classes)
Behavioral contracts (for example, a signed commitment to attend cardiac rehabilitation)
Incentive programs (giving away T-shirts, water bottles, parking passes, books and so forth after a certain number of sessions, etc.)
Other: ___________________________
We do not do any of the above
Utilization and Expansion
11. Which of the following times of day does your program provide phase II outpatient cardiac rehabilitation exercise sessions? Please consider only the start times of any activities. (Check all that apply)
Early morning (before 8 AM)
Morning (8-11 AM)
Noon (12 PM)
Afternoon (1-4 PM)
Evening (after 5 PM)
12. Which days of the week does your program provide phase II outpatient cardiac rehabilitation exercise sessions? (Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
13. In the year 2011, approximately how many new patients enrolled in your phase II outpatient cardiac rehabilitation program by attending ≥ 1 exercise session?
__________________ (number of new patients in 2011)
14. For the next 12 months, approximately how many new patients do you estimate that your phase 2 outpatient cardiac rehabilitation program could enroll and treat (≥ 1 exercise session), assuming you were able to operate at your maximal possible capacity?
__________________ (maximum annual patient capacity)
15. For the next 12 months, approximately how many new patients do you estimate that your phase 2 outpatient cardiac rehabilitation program could enroll and treat (≥ 1 exercise session), assuming a significant increase in patient demand and a realistic increase in program capacity (based on a realistic increase in personnel, space, equipment, and other resources that could be approved by your administrators)?
__________________ (Annual patient capacity assuming realistic program expansion)
16. Suppose your program instituted a practice improvement project that was successful and subsequently increased the number of participants in your program by 20% (e.g.
from 100 to 120 appointments/week.) How easy or difficult would it be for your program to expand to meet the needs of this increased volume of patients?
Very easy, could be done tomorrow
Somewhat easy
Possible, with some obstacles
Somewhat difficult
Very difficult/impossible, could not be done in the next year
17. Of all obstacles your phase II outpatient cardiac rehabilitation program has to increasing patient participation, which is your greatest obstacle and why?
____________________________________________________ (free response box)
Hospital Referral
18. Regarding the inpatient practices of your principal referring hospital to your phase II outpatient cardiac rehabilitation program, do you have specific knowledge of their current referral process?
Yes
No (please skip to question 23)
19. For purposes of this question, a systematic referral process is defined as a systematic, non-manual referral of all eligible patients with cardiac disease, usually as part of an order set, standing order, computer prompt, or similar semi- or fully-automatic process.
Such a system does not rely on physician, nurse, or staff memory or initiative.
Regarding the inpatient practices of your principal referring hospital, do they utilize a systematic referral process to phase II outpatient cardiac rehabilitation at any point during a patient’s hospitalization?
Yes
No
Unsure
20. If you answered yes to question #19, at what time point(s) during the hospitalization in your principal referring hospital does systematic referral occur? (Check all that apply)
Upon admission to the hospital
At the time of cardiac surgery
At the time of cardiac catheterization with revascularization
At the time of positive stress test
At the time of positive biomarker (troponin elevation, CK-MB elevation)
At the time of discharge from the hospital
After patient discharge from the hospital
Other: _______________________
Not applicable, our principal referring hospital does not use a systematic referral 21. For the purpose of this question, a cardiac rehabilitation liaison is defined as a specific designee (usually a nurse or exercise professional) from either the hospital or rehabilitation program who systematically approaches all eligible patients to facilitate and encourage hospitalized patients to participation in outpatient cardiac rehabilitation.
Regarding the inpatient practices of your principal referring hospital, do they utilize a liaison as part of their referral process?
Yes
No
Unsure
22. Regarding the inpatient practices of your principal referring hospital, which of the following is given to patients in the hospital at the time of their cardiac rehabilitation referral? (Check all that apply.)
An appointment with specific time and date for cardiac rehabilitation first session
Flyer/pamphlet/video discussing benefits of cardiac rehabilitation
Map/directions to cardiac rehabilitation program location
Contact phone number for the cardiac rehabilitation program
Other: ____________________
Unsure
None of these
Outpatient Office/Clinic Referral
23. Regarding the outpatient practices of your principal referring office/clinic to your early outpatient cardiac rehabilitation program, do you have specific knowledge of their current cardiac rehabilitation referral process?
Yes
No (please skip to question 26)
24. For purposes of this question, a systematic referral process is defined as a systematic, non-manual referral of all eligible patients with cardiac disease, usually as part of an order set, standing order, computer prompt, or similar semi- or fully-automatic process.
Such a system does not rely on physician, nurse, or staff memory or initiative.
Regarding the outpatient practices of your principal referring office/clinic, do they utilize a systematic referral process as part of the office visit?
Yes
No
Unsure
25. Regarding the outpatient practices of your principal referring office/clinic, which of the following is given to eligible patients at the time of their cardiac rehabilitation referral? (Check all that apply.)
An appointment with specific time and date for cardiac rehabilitation first session
Flyer/pamphlet/video discussing benefits of cardiac rehabilitation
Map/directions to cardiac rehabilitation program location
Contact phone number for the cardiac rehabilitation program
Other: ____________________
None of these
Measurements and Participation Rates
For Questions #26-30, please use the following definitions:
Hospital referral rate: The percentage of eligible patients from your principal referring hospital who were referred to phase II outpatient cardiac rehabilitation (i.e., the number of patients referred to cardiac rehabilitation divided by the number of eligible patients).
Outpatient office referral rate: The percentage of eligible outpatients from your principal referring outpatient office/clinic who were referred to phase II outpatient cardiac
rehabilitation (i.e., the number of patients referred to cardiac rehabilitation divided by the number of eligible patients).
Program enrollment rate: The percentage of patients who have been referred to your phase II outpatient cardiac rehabilitation program who attended at least one exercise session.
Program completion rate: The percentage of patients who attended at least one phase II exercise session who completed the prescribed number of cardiac rehabilitation sessions.
26. For your cardiac rehabilitation program, have you ever, even once, in the past 5 years measured any of the following rates, by means of a formal process such as reviewing medical records, cardiac rehabilitation program records, or billing records?
Hospital referral rate (Yes/No/Unsure/Unable to measure)
Outpatient office referral rate (Yes/No/Unsure/Unable to measure)
Program enrollment rate (Yes/No/Unsure/Unable to measure)
Program completion rate (Yes/No/Unsure/Unable to measure)
27. For your cardiac rehabilitation program, have you ever, even once, in the past 5 years carried out a practice improvement project to increase any of the following rates?
Hospital referral rate (Yes/No/Unsure/Unable to change)
Outpatient office referral rate (Yes/No/Unsure/Unable to change)
Program enrollment rate (Yes/No/Unsure/Unable to change)
Program completion rate (Yes/No/Unsure/Unable to change) 28. For each of the following, please fill in the percentage for your primary referring hospital, your primary referring outpatient practice, and your CR program for the year 2011 (e.g., 47% Hospital referral rate for 2011.) If you do not know this information from memory, please take a minute or two to look it up.
Hospital referral rate ______________ (number, between 0-100)
Outpatient office referral rate ______________ (number, between 0-100)
Program enrollment rate ______________ (number, between 0-100)
Program completion rate ______________ (number, between 0-100) 29. For your reported rates in question #28, was your rate measured or estimated?
Hospital referral rate (Measured/Estimated)
Outpatient office referral rate (Measured/Estimated)
Program enrollment rate (Measured/Estimated)
Program completion rate (Measured/Estimated)
Thank you for your help in completing this information.
Please take a moment to double check your answers to each of the items in the survey.
Incentive
30. (Optional) If you would like to be entered into the drawing, please enter your email below. This information will be kept separate from the survey information and will be kept secure. Winners will be mailed their free books in approximately 6-8 weeks.
Email_________________________
Thank you, again, for taking time to complete this survey!
