By Serena Agusto-Cox | News & Views

Cardiovascular and pulmonary rehabilitation (CR/PR) programs are not just a health care service. These programs are critical to patient care and should be strategic in how they approach operations so they can widen patient access. An AACVPR webinar in February, Impact of Program, Management, and Organizational Structure on Operations, Growth, and Sustainability with Gregory Scharf, BS, ACSM-CEP, AACVPR-CCRP, cardiac and pulmonary rehab manager at MyMichigan Health, explored how CR/PR programs can achieve growth and sustainability no matter what their organizational structure looks like. Program staff and leaders heard how best to navigate their organizational structure to improve patient care and outcomes.

Educate to Promote Understanding and Advocacy

The first step CR/PR programs can take toward growth and sustainability is to educate providers, leaders, and patients about what the programs offer, how the programs operate, and what value they provide to patient care. Scharf says, “Educating leaders, patients, and others about the value and expectations of CR/PR and the availability of care can improve awareness about the program to those referring patients.”

Secondly, he says mid-level leaders may be unaware of the operational needs of CR/PR programs or may not fully understand the regulatory requirements or clinical best practices of the program. “Informing leaders about these requirements, practices, and operational needs can help the CR/PR programs achieve wider department exposure, or ‘a seat at the table’ where decisions are made,” explains Scharf.

Structure Impacts Awareness and Patient Outcome Reporting

According to Scharf, “Our programs are dissimilar to other health care services because they face different regulatory nuances and can often be categorized within an organization’s structure in different ways.” Where CR/PR falls within a health care system will dictate who the program reports to; in some cases, the programs are so small that some staff report directly to the director of the larger department.

Additionally, CR/PR programs can have different focuses depending on their health care environment. For example, hospitals will have a patient care strategy that differs from private practice. Scharf’s program is part of rehab services, but it does see the same patients that would be seen in other rehab services, such as physical therapy or occupational therapy. Another program may fall under the cardiovascular department. “Each CR/PR program would have a different reporting structure. For instance, musculoskeletal strategic planning is not the same as working under cardiovascular strategic planning,” he says.

These programs need to understand and navigate these structures effectively in order to improve patient-care access and outcomes. Scharf adds, “The goal should be to make CR/PR more sustainable in more locations that are closer to patients homes and that utilizes available technology.”

Metrics Are Key to Showing Patient Care Value

Scharf points out that patient and program outcomes are essential when reporting to leaders about the success of the program. Data sheets and other resources are available in the AACVPR Registry. He also notes that CR/PR programs need to know what the hospital’s care benchmarks are. If a program is not meeting those targets, Scharf says, “use the data to identify and evaluate possible quality improvement (QI) projects.”

The most useful data to collect and evaluate for patient care include:

• Participation rates
• Dropout rates
• Days between discharge and referral and when patients begin the program
• Clinical outcomes for each patient

These data points should be measured against benchmarks. “Don’t forget to provide context with the data,” he says. “If the CR program’s participation rate is 65%, and staff only present the figure without context in a presentation, leaders may not view that rate as positive.” For instance, if the average among other CR programs is a 41% participation rate, 65% participation is a better outcome. “Our program ranks fourth out of 31 cardiac rehab programs,” says Scharf. “Being able to validate your data against other programs and present it to leaders can better demonstrate the program’s value in patient care.”

“CR/PR programs can learn to move beyond a focus on operations and providing services to patients to becoming a strategic partner in patient care through self-evaluation efforts,” says Scharf. “Learning where there are missing rungs in the leadership ladder and how to overcome possible barriers to growth will set these programs up for future, sustainable growth.” He adds, “Modifications are likely to look different for each CR/PR program as they begin to connect the dots for reporting and care improvement. Moving forward will also require each program’s historical understanding of how they made it to where they are today.”

Each program must evaluate, educate, and navigate the operational structure they have in order to surmount possible barriers to better care. With that in mind, programs can leverage their patient outcome data to achieve growth, widen care access, and validate their value in caring for patients.