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Chapter 2. The Cardiac Rehabilitation Continuum of Care. JCAHO. Joint Commission on Accreditation of Healthcare Organizations

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Chapter 2

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Chapter 2

The Cardiac Rehabilitation Continuum of Care


JCAHO

  • Joint Commission on Accreditation of Healthcare Organizations

  • Defines the continuum of care as a quality component of patient care consisting of the degree to which the care a patient needs is coordinated among practitioners and across organizations over time


Continuum Barriers

  • Shorter lengths of stay

  • Duration of CR services

  • Added services, programming

  • Staffing

  • Outcomes

  • Table 2.1


Expanded Services

  • Risk Factor Intervention Programs

  • Education & Counseling

  • Additional Exercise Training

  • Special Populations


Figure 2.1 - Inpatient

  • Average length of stay = 3-4 days

  • Progressive activity in pathways

  • Education focused on ‘survival needs’

  • Post hospital follow-up

  • Sicker pts = transitional care

  • Some home health

  • Healthier pts = 1-2 weeks start rehab.


Figure 2.1 – Early Outpatient

  • Starts rehab. sooner

  • Shorter rehab. stay

  • Emphasis on Risk Factor Reduction

  • Risk stratification

  • Greater self-monitoring

  • Increased care with primary physicians

  • Alternative settings

  • Measurement of selected outcomes


Figure 2.1 - Maintenance

  • Begins 2-3 months

  • Community based ( high school gym, hospital wellness center, YMCA, commercial fitness club)

  • Checkups (telephone, onsite, mailed surveys)

  • Access to continuing education (hospital, internet)


Challenges

Budget Cuts = Less staff

Shortened lengths of stay

Opportunities

Shared responsibility – other caregivers

Professional alliance – home health, transitional care units, etc.

Inpatient Challenges & Opportunities


Challenges

Budget Cuts – limit varied staff

Fewer exercise visits covered

Opportunities

Risk factor triage

Internet supplements

Telephone follow-up

Outpatient Challenges & Opportunities


Challenges

Out-of-pocket expenses

Logistics issues

General inability to continue

Opportunities

Rehab. checkup day

Telephone follow-up

Maintenance Challenges & Opportunities


Periodic exercise check-ups

Independent Rx

Unsupervised Rx

Resistance training

Submax fitness testing

Supervised training

Stress management

Telephone follow-up

Telemetry

GXT

Menu – Exercise Services


Blood Pressure

Diabetes Education

Lipid Monitoring

Medication Teaching

Risk factor check-ups

Psychological referrals

Smoking cessation

Support groups

Weight loss programs

Vocational counseling

Self-monitoring skills

Menu – Education, Counseling, & Behavioral


Core Components – Figure 2.4

  • Page 13 – 16.


Cardiac Rehab. Barriers

  • 11-38% of candidates receive CR

  • Logistics

  • Lack of physician referral

  • Lack of personal support system

  • Economics

  • Patient prefers not to exercise


Rehab. Alternatives

  • Nurse case management telephone calls

  • Home exercise w/ transtelephonic monitoring

  • Computer guided programs

  • Intensive diet therapy & psychological counseling


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