Combining case management, pathways, and report cards for secondary cardiac prevention

Area of Science:

• Cardiology
• Preventive Medicine
• Health Services Research

Background:

• Traditional cardiac rehabilitation often lacks long-term follow-up.
• Butterworth Hospital initiated a program in 1995 for sustained cardiovascular risk factor modification.
• This initiative shifted focus from treatment to prevention.

Purpose of the Study:

• To describe the development and components of a comprehensive cardiac prevention and rehabilitation program.
• To evaluate the program's integration into clinical practice and its impact on patient enrollment.
• To assess the program's effectiveness as a tool for secondary cardiac disease prevention.

Main Methods:

• Implementation of an outpatient extension of inpatient cardiovascular pathways, integrated into the electronic medical record.
• Utilized a "report card" system inspired by Dartmouth Medical Center, incorporating value compass and instrument panel approaches for quality improvement.
• Collected data on cost, utilization, patient satisfaction, functional health status, and clinical outcomes.

Main Results:

• Quarterly patient enrollment increased from under 15% to 32% of eligible patients since the program's inception in January 1995.
• Regularly issued internal "report cards" (June 1996, Sept 1996, Jan 1997) to track progress and drive improvements.
• The program demonstrated successful integration and growth in patient participation.

Conclusions:

• The integrated approach combining case management, clinical pathways, an outcomes database, and report cards proved effective.
• This model creates a marketable program for the secondary prevention of cardiac disease.
• The program successfully addresses the need for long-term cardiovascular risk factor management.