The Cardiac Rehabilitation Referral Improvement in a Safety-Net Population (CRISP) Initiative

Cardiac rehabilitation (CR) reduces morbidity and mortality after myocardial infarction, yet referral rates remain low, especially in safety-net hospitals and among women.

At Los Angeles General Medical Center, baseline CR referral was <25%, with marked sex-based disparities. Despite access to a county-affiliated CR facility, women were substantially under-referred. To address this, we launched the Cardiac Rehabilitation in a Safety-Net Population (CRISP) initiative, combining provider education, workflow tools, and a referral-tracking pipeline. In the year after implementation, referrals rose from 12.9% to a peak of 58.8%, averaging 43.8%-a 31% absolute increase and 3.4-fold improvement.

The CRISP initiative demonstrates that sustainable infrastructure and provider awareness can markedly improve CR referral in underserved settings. However, women continued to be referred at lower rates (26.0% vs 45.5% for men), underscoring the need for targeted interventions and automated referral pathways.

System-level tools can improve CR access, but deliberate strategies are required to achieve equity.