Implementation of Evidence-Based, Person-Centered Alternative Delivery Models for Cardiac Rehabilitation in a Rural...

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Cardiac rehabilitation (CR) access and adherence are suboptimal, especially in rural settings.
• A person-centred, evidence-based CR delivery model was developed to address these disparities.
• The Country Heart Attack Prevention (CHAP) project implemented this flexible model.

Purpose of the Study:

• To evaluate the implementation and effectiveness of the CHAP project's person-centred CR model.
• To compare CR attendance, completion, and clinical outcomes between the CHAP model and standard CR.
• To assess the cost-effectiveness of the CHAP model.

Main Methods:

• Utilized the Model for Large-Scale Knowledge Translation framework.
• Implemented flexible CR options: face-to-face, telehealth, telephone, web-based, and primary care.
• Conducted a matched prospective cohort study comparing CHAP rural services with standard metropolitan CR.

Main Results:

• CR attendance was comparable (24.2% vs 23.8%), but completion rates were significantly higher in CHAP (77.1% vs 57.5%).
• Patient satisfaction was greater in CHAP (85.9% vs 77.1%), with similar waiting times.
• CHAP demonstrated equivalent clinical outcomes (CV readmissions, mortality, ED visits) and was more cost-effective.

Conclusions:

• The CHAP Project successfully improved CR completion and patient satisfaction without compromising clinical outcomes.
• The model showed significant economic benefits, with potential cost reductions of $2-10 million.
• Broader implementation of person-centred CR models is recommended for underserved populations.