Abstract 7: Health Care System Re-Design to Achieve Universal Access to Cardiac Rehabilitation Services: Implications for Population Health and Health Policy
Notice bibliographique
Résumé
Background: The efficacy of cardiac rehabilitation programs (CRP) is well established, and completion of such programs after an event is standard-of-care in guidelines worldwide. Despite universal recommendations, participation in CRP is alarmingly low: estimated at 14%-35% in the US, and <15% of eligible patients in the Canadian province of Ontario. The inability to achieve even 50% participation in CRP represents a failure of health care systems (HCS) to deliver effective, high-quality services. Such a failure is particularly vexing in Canada, where the central tenet and legal requirement of the HC-S is universal access to all medically necessary services. Objectives: A team of health care providers and administrators in Ontario used a systems integration approach to re-design the HCS in one health care region (HCR) to make an evidence-based CRP universally available. The key features of this HCS-integrated CRP (HCS-I-CRP), its adoption, and population health impact are reported here. Methods: By design, the HCS-I-CRP included harmonized criteria that triggered automatic referral to a HCR-wide coordinating center, which then directed eligible patients to a CRP provided in local, community-based setting (LCB-CRP). Fourteen LCB-CRP, available within a 30-minute drive from most all locations in the HCR, were trained to provide a standardized CRP. Detailed patient outcomes were tracked in a centralized database. Using administrative data, within-HCR participation rates were monitored, and population level health impacts between the HCR implementing the HCS-I-CRP and all other HCRs in Ontario were compared for the 2 years prior and 1 year after the HCS-I-CRP implementation. Results: More than 11,000 patients were referred through the HCS-I-CRP to a LCB-CRP. The estimated overall participation and completion rates were 31% and 67%, respectively. Population health impacts in the HCR implementing the HCS-I-CRP included (p<0.05): larger HCR-wide reduction in visits to family practitioners, cardiologists, and internists for any cardiac reason; larger HCR-wide reductions in hospitalizations, emergency department visits, and visits to cardiologist and internists for acute coronary syndrome; and larger HCR-wide reductions in visits to family practitioners and cardiologists for heart failure. Reductions in HCR-wide mortality for acute coronary syndrome approached significance (p=0.097). Conclusions: The adoption of a HCS-I-CRP was extremely successful: referrals actually exceeded the capacity of LCB-CRPs and enrollment, unfortunately, had to be capped. Despite this, statistically significant, population level health benefits were observed. We anticipate that adoption of a province-wide HCS-I-CRP, initiated and buttressed by provincial policy, would achieve near universal access to CRP and population health benefits similar to or greater than those reported here.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».