Hospital-level variation in cardiac rehabilitation metrics
Authors' conclusion
Substantial variation across hospitals, including peer hospitals within the same tier of cardiac care, indicates opportunities for hospital-level quality improvement strategies to improve CR referral and participation metrics.
Study context
- Population
- US hospitals with ≥20 cardiac rehabilitation (CR)-qualifying events (acute myocardial infarction (AMI), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in 2018) among Medicare fee-for-service (FFS) beneficiaries aged ≥65 years
- Participants
- 2,212 hospitals
- Exposure
- Hospital tiers of cardiac care: comprehensive vs AMI/PCI vs AMI-only
- Outcome
- Hospital-level variation in CR metrics (CR enrollment)
Methodological detailsnational, multi-level models, Medicare FFS data (2018-2020), Parts A and B, and American Hospital Association (AHA) data (2018)
- National
- Multi-level models
- Medicare FFS data (2018-2020), Parts A and B, and AHA data (2018)
Main finding
As reported in the abstract
CR enrollment, all hospitals
All hospitals
19.6%
median · IQR 7.0%–32.8%
Observational data: associations, not effects.
Further findings
Median
| Outcome | Comprehensive | AMI/PCI | AMI-only |
|---|---|---|---|
| CR enrollment by tier of cardiac care | 30.7% (IQR 20.7%–41.3%) | 18.6% (IQR 9.5%–27.7%) | 0.0% (IQR 0.0%–7.7%) |
- CR enrollment by tier of cardiac care: 44.4% comprehensive, 31.2% AMI/PCI, 24.4% AMI-only hospitals
- Time to enrollment, number of CR sessions, percent completion (hospitals with enrollment): Hospitals with enrollment median 55.0 (IQR 41.0–71.0) days · Median CR sessions 26.0 (IQR = 23.0, 29.0) · Median percent completion 26.0% (IQR = 10.5%, 41.2%)
- Time to enrollment, number of CR sessions, percent completion (hospitals with enrollment): n = 1,866 hospitals with enrollment
Factors associated with lower odds of CR enrollment (adjusted)
- Patient-level: older age, female sex, non-White race or ethnicity
- Hospital-level: for-profit ownership, regions other than the Midwest, rural location, medium/large hospital size
Original publication
Hospital-level variation in cardiac rehabilitation metrics. Am Heart J. Published 13 December 2024. doi:10.
Summarised from the published abstract; every number is checked against it