Introduction of a novel service model to improve uptake and adherence with cardiac rehabilitation within Buckinghamshire Healthcare NHS Trust

Fiona Mccartan,Mirren Mandalia,Piers Clifford,Anna Bishop-Bailey,Nayan Kalnad,Jack Turner,Nicola Bowers,Jiayu Fu

doi:10.1186/s12872-017-0606-2

Fiona Mccartan, Mirren Mandalia + Show 6 more

Open Access

https://doi.org/10.1186/s12872-017-0606-2

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Abstract

BackgroundBuckinghamshire Healthcare NHS Trust (BHT) carried out a cardiac rehabilitation (CR) service redesign aimed at optimising patient recruitment and retention and decreasing readmissions.MethodsA single centre observational study and local service evaluation were carried out to describe the impact of the novel technology-enabled CR model. Data were collected for adult patients referred for CR at BHT, retrospectively for patients referred during the 12-month pre-implementation period (Cohort 1) and prospectively for patients referred during the 12-month post-implementation period (Cohort 2). The observational study included 350 patients in each cohort, seasonally matched; the service evaluation included all eligible patients. No data imputation was performed.ResultsIn the observational study, a higher proportion of referred patients entered CR in Cohort 2 (84.3%) than Cohort 1 (76.0%, P = 0.006). Fewer patients in Cohort 2 had ≥1 cardiac-related emergency readmission within 6 months of discharge (4.3%) than Cohort 1 (8.9%, P = 0.015); readmissions within 30 days and 12 months were not significantly different. Median time to CR entry from discharge was significantly shorter in Cohort 2 (35.0 days) than Cohort 1 (46.0 days, P < 0.001). The CR completion rate was significantly higher in Cohort 2 (75.6%) than Cohort 1 (47.4%, P < 0.001); median CR duration for completing patients was significantly longer in Cohort 2 (80.0 days) than Cohort 1 (49.0 days, P < 0.001). Overall, similar results were observed in the service evaluation.ConclusionsIntroduction of the novel technology-enabled CR model was associated with short-term improvements in emergency readmissions and sustained increases in CR entry, duration and completion.

Highlights

Buckinghamshire Healthcare NHS Trust (BHT) carried out a cardiac rehabilitation (CR) service redesign aimed at optimising patient recruitment and retention and decreasing readmissions
Buckinghamshire Healthcare NHS Trust (BHT) identified the need for a CR service redesign due to poor CR recruitment and completion rates, and use of paper-based records impaired data-sharing across the CR team
In the service evaluation, patients referred for CR in Cohorts 1 and 2 were well matched except for a significantly higher proportion of patients with heart failure (HF) in Cohort 2 (6.5%) compared with Cohort 1 (1.8%, adjusted P < 0.001; see Table 3)

Summary

Introduction

Buckinghamshire Healthcare NHS Trust (BHT) carried out a cardiac rehabilitation (CR) service redesign aimed at optimising patient recruitment and retention and decreasing readmissions. Buckinghamshire Healthcare NHS Trust (BHT) identified the need for a CR service redesign due to poor CR recruitment and completion rates (only 47% of all enrolled patients completed CR and only 5 patients with chronic heart failure were referred for CR annually), and use of paper-based records impaired data-sharing across the CR team. Janssen Healthcare Innovation, a division of JanssenCilag UK, supported the patient-centric CR service redesign at BHT with a programme, Care4Today® Heart Health Solutions. The novel CR service, implemented in 2013, was aimed at optimising patient recruitment and retention, decreasing readmissions and increasing patient and staff satisfaction. The key characteristics of the pre- and post-service redesign CR programmes are summarised on Table 1

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