Abstract 7: Health Care System Re-Design to Achieve Universal Access to Cardiac Rehabilitation Services: Implications for Population Health and Health Policy
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".