Improving referral rates and utilization of a pediatric cardiac rehabilitation program for patients with congenital and pediatric acquired heart disease

Abstract

BackgroundCardiac Rehabilitation Programs specifically for young patients with congenital and pediatric acquired heart disease are known to be beneficial but are relatively new. Referral, utilization, and insurance approval rates for a cardiac rehabilitation program that serves pediatric congenital and acquired heart disease populations have yet to be examined, but it is known that cardiac rehabilitation programs for adults with atherosclerotic disease have historically poor utilization. This study evaluated program metrics and barriers to participation for the congenital and pediatric acquired heart disease population. ObjectivesThe purpose of this study was to analyze rates of referral, utilization, and insurance approval as well as capture reasons for attrition. MethodsOutpatients ≥8 years old seen at Boston Children's Hospital with eligible diagnoses were captured from 01/2017 to 12/2020. Referral and participation numbers were compared to the total eligible and analyzed using frequency and percent counts. Patient demographics, diagnoses, insurance providers and authorizations, and reasons for attrition were tracked and analyzed. Results7558 unique patients met eligibility criteria; 175 total patients were referred to the cardiac rehabilitation program yielding a 2 % referral rate. Most of the referrals (69 %) had congenital heart disease (CHD), and the rest had pediatric acquired conditions. Insurance coverage was approved by 91 % of total participants contacted. Out of 175 referred, 75 (43 %) unique patients participated in the program (<1 % utilization rate). The majority (73 %) of participating patients were <21 years old. ConclusionDespite the proven benefit, referral and utilization rates for cardiac rehabilitation for patients with congenital and pediatric acquired heart disease are alarmingly low and up to 35-fold worse than the known low utilization rates for coronary heart disease. Insurance coverage was surprisingly not a barrier, and improving the insurance process and increasing awareness of referring providers emerged as important targets to address.