Background:Despite its established benefit and strong endorsement in international guidelines, cardiac rehabilitation (CR) use remains low. Identifying determinants of CR referral and use may help develop targeted policies and quality improvement efforts. We evaluated the variation in CR referral and use across percutaneous coronary intervention (PCI) hospitals and operators.Methods:We performed a retrospective observational cohort study of all patients who underwent PCI at 48 nonfederal Michigan hospitals between January 1, 2012 and March 31, 2018 and who had their PCI clinical registry record linked to administrative claims data. The primary outcomes included in-hospital CR referral and CR participation, defined as at least one outpatient CR visit within 90 days of discharge. Bayesian hierarchical regression models were fit to evaluate the association between PCI hospital and operator with CR referral and use after adjusting for patient characteristics.Results:Among 54 217 patients who underwent PCI, 76.3% received an in-hospital referral for CR, and 27.1% attended CR within 90 days after discharge. There was significant hospital and operator level variation in in-hospital CR referral with median odds ratios of 3.88 (95% credible interval [CI], 3.06–5.42) and 1.64 (95% CI, 1.55–1.75), respectively, and in CR participation with median odds ratios of 1.83 (95% CI, 1.63–2.15) and 1.40 (95% CI, 1.35–1.47), respectively. In-hospital CR referral was significantly associated with an increased likelihood of CR participation (adjusted odds ratio, 1.75 [95% CI, 1.52–2.01]), and this association varied by treating PCI hospital (odds ratio range, 0.92–3.75) and operator (odds ratio range, 1.26–2.82).Conclusions:In-hospital CR referral and 90-day CR use after PCI varied significantly by hospital and operator. The association of in-hospital CR referral with downstream CR use also varied across hospitals and less so across operators suggesting that specific hospitals and operators may more effectively translate CR referrals into downstream use. Understanding the factors that explain this variation will be critical to developing strategies to improve CR participation overall.

中文翻译：

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经皮冠状动脉介入治疗后心脏康复转诊和参与的医院和运营商变化：来自密歇根心血管联盟蓝十字蓝盾的见解

背景：尽管心脏康复 (CR) 的使用已经确立并得到国际指南的大力支持，但它的使用率仍然很低。确定 CR 推荐和使用的决定因素可能有助于制定有针对性的政策和质量改进工作。我们评估了经皮冠状动脉介入治疗 (PCI) 医院和操作者之间 CR 转诊和使用的差异。谁的 PCI 临床注册记录与行政索赔数据相关联。主要结局包括院内 CR 转诊和 CR 参与，定义为出院 90 天内至少一次门诊 CR 就诊。调整患者特征后，采用贝叶斯分层回归模型评估 PCI 医院和操作者与 CR 转诊和使用之间的关联。 结果：在 54 217 例接受 PCI 的患者中，76.3% 接受院内转诊以获得 CR，27.1%出院后 90 天内参加 CR。院内 CR 转诊的医院和操作员水平差异显着，中位优势比分别为 3.88（95% 可信区间 [CI]，3.06-5.42）和 1.64（95% CI，1.55-1.75），在 CR 中参与的中位优势比分别为 1.83（95% CI，1.63–2.15）和 1.40（95% CI，1.35–1.47）。院内 CR 转诊与 CR 参与的可能性增加显着相关（调整后的优势比，1.75 [95% CI，1.52–2.01]），这种关联因治疗 PCI 医院（优势比范围，0.92-3.75）和操作者（优势比范围，1.26-2.82）而异。结论：院内 CR 转诊和 PCI 后 90 天 CR 使用因医院和操作者而异. 院内 CR 转诊与下游 CR 使用的关联也因医院而异，而不同运营商之间差异较小，这表明特定医院和运营商可以更有效地将 CR 转诊转化为下游使用。了解解释这种变化的因素对于制定提高整体 CR 参与的策略至关重要。院内 CR 转诊与下游 CR 使用的关联也因医院而异，而不同运营商之间差异较小，这表明特定医院和运营商可以更有效地将 CR 转诊转化为下游使用。了解解释这种变化的因素对于制定提高整体 CR 参与的策略至关重要。院内 CR 转诊与下游 CR 使用的关联也因医院而异，而不同运营商之间差异较小，这表明特定医院和运营商可以更有效地将 CR 转诊转化为下游使用。了解解释这种变化的因素对于制定提高整体 CR 参与的策略至关重要。