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Bastiaan Nakano
August 9, 2017


What is Hybrid Cardiac Rehab? - Part 1, Introducing Hybrid CR and Patient Types

Cardiac rehabilitation (CR) is a crucial component of a post-acute care for cardiac patients. Despite its benefits, program and patient-side barriers are hindering CR programs from serving more patients. For many patients, barriers such as distance, transportation and cost, make CR inaccessible. To address these barriers new models for delivering CR are needed and the Hybrid Cardiac Rehab model is answering the call.

The Hybrid Cardiac Rehab Model
So, what is Hybrid Cardiac Rehab? Hybrid Cardiac Rehab is a model of care delivery consisting of both center-based and home-based CR sessions. It is designed to increase access to CR for candidates who have difficulty attending 3 sessions per week. The hybrid model also incorporates mobile technology including mobile apps and activity trackers to help patients do their rehab from home.

In order for a patient to participate in Hybrid Cardiac Rehab, their ability to frequently attend on-site sessions must be assessed during the CR intake visit or orientation. Once assessed, the patient is placed into one of three patient types: Type 1 patients are able to attend all onsite CR sessions; Types 2 patients can attend fewer than 3 sessions a week due to barriers such as co-pays or work conflicts; Type 3 patients are unable to attend onsite CR because they live too far away or have limited transportation options. The goal of the hybrid program is to identify each patient’s ability to attend and provide them with a home program to augment the skipped on-site sessions.

Hybrid CR Program Flow Diagram

Program Workflow and Patient Types
All eligible patients are invited to an intake/orientation session in which they do a baseline exercise test and receive an individual treatment plan (ITP). During the intake visit, patients are assessed for their ability to attend onsite sessions and safely exercise from home; after which they are classified into the appropriate patient type.

Type 1
Since Type 1 patients can attend onsite CR regularly the goal of a home program is to reinforce the new behaviors being taught in the on-site sessions.

Type 2
Type 2 patients usually can attend onsite CR once a week. To augment for sessions missed, they are prescribed a home-based exercise and education plan. Cardiac rehab nurses encourage Type 2 patients to attend as many onsite CR sessions as possible.

Type 3
Type 3 patients are unable to attend any onsite sessions. In the hybrid model these patients are enrolled in a completely home based program. In the home program the patients receive a care plan which is a derivate of the ITP but contains instructions for patients to safely complete their rehab from home. To substitute for the on-site sessions Type 3 patients are coached on home exercise and education to improve their cardiovascular risk factors through structured phone calls. During the first month, patients receive weekly phone calls to discuss their progress; for the second and third months, calls occur bi weekly. Delivering CR through remote coaching has been proven to be effective in many clinical studies and in health systems like the VA and Kaiser Permanente.

The Role of Technology in Hybrid CR
Implementing a hybrid program poses a new set of challenges: the tracking of patients in different models; monitoring of home exercise sessions; communicating effectively with patients. New care management platforms that include mobile apps for patients and dashboards for clinicians, can greatly improve the implementation of a hybrid program. For example, patients can use a mobile app as a self management tool to log their home exercises, track vitals and create medication reminders. Cardiac rehab nurses and staff use a dashboard connected to the mobile app to communicate with patients through video calls or text messages, remote monitor exercise and vitals, and push interactive education materials. These technologies improve patient engagement and self management, which helps patients gain the necessary skills needed to independently maintain a healthy lifestyle after they graduate from CR.

Conclusion
Hybrid Cardiac Rehab provides a robust solution for CR centers that experience barriers to the delivery of care. The model offers increased flexibility and access to care for patients who may otherwise go without. The hybrid model can also be used to reduce waitlists and improve the utilization of limited physical space. Care management platforms like Moving Analytics enables CR centers to engage and monitor patient remotely, which can help decrease unnecessary emergency departments visits and hospital readmissions. Many programs are currently implementing hybrid CR including Lady of Lourdes Medical Center and Northwest Community Hospital.

This has been Part 1 of What is Hybrid Cardiac Rehab. Parts 2 and 3 will be available late August and Sept and will focus on staff/equipment requirements and the business case for Hybrid CR, respectively.


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