Shannon Gravely, PhD, Postdoctorate Fellow

1. A PATIENT NAVIGATION INTERVENTION IMPROVED ENROLLMENT IN OUTPATIENT CARDIAC REHABILITATION: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL Assessed for eligibility (N=599) Randomized (N= 181) PN (n= 91) Usual Care (n= 90) PN (n= 89, *2 deaths) UC (n= 89, *1 death) • Shannon Gravely, PhD, Postdoctorate Fellow • Lisa Benz Scott, PhD, Associate Professor, School of Health Technology and Managem • David L. Brown, MD, Professor of Cardiovascular Medicine • Thomas R. Sexton, PhD, College of Business • Stony Brook University, Hospital and Health Sciences Center, Stony Brook, New York Abstract Conclusions Results Methods • This study was controlled trial located at Stony Brook University Hospital (SBUH) and Health Sciences Center, Long Island, New York. The protocol was approved by the Committee on Research Involving Human Subjects at Stony Brook University. • SUBJECTS • Eligible patients were screened and consented at the bedside prior to hospital discharge by nurses at the General Clinical Research Center at SBUH. • Inclusion criteria are based on clinical indicators for OCR referral: • Age 21 years or older • at least ONE of the following as a primary diagnosis: • Myocardial Infarction • Coronary Artery Bypass Surgery (CABG) • Percutaneous Coronary Angioplasty • Heart valve repair / replacement • Stent placement • Stable angina pectoris • Consented patients are consecutively assigned to either Usual Care (UC) or Patient Navigation (PN) using computer-generated block randomization. • Background: Cardiovascular disease is the leading global cause of morbidity and mortality. Although outpatient cardiac rehabilitation (OCR) has been shown to reduce morbidity and mortality and is recommended by clinical practice guidelines for secondary prevention of heart disease, enrollment remains suboptimal. More, interventions are needed to improve cardiac care transitions from inpatient to outpatient settings and assist patients to access evidence-based services. • Purpose: This randomized controlled trial (RCT) tested the effect of an innovative cardiac Patient Navigation (PN) intervention, “Your Health, Your Way” on rates of enrollment into OCR among eligible cardiac patients within 12 weeks post-hospitalization at Stony Brook University Hospital. • Methods: • Eligible cardiac patients were consented during inpatient care at a participating academic medical center. • Clinical and sociodemographic data were collected from medical charts and/or self-report during telephone interviews performed by research staff within 4 weeks, and again at 12 weeks months post-hospitalization • Enrollment into an OCR program was verified by staff at local CR program sites. • Group differences in enrollment rates were assessed using Fisher’s Exact Test (one-tailed, alpha .05). • A multivariate logistic regression was used to examine if the PN intervention resulted in significantly more patients enrolled in OCR compared to UC patients. randomly assigned to either PN (n= 57) or Usual Care (n= 57). • Results: Of the 181 study participants, 3 died within one month of hospital discharge. Of the remaining 178 patients, 27 (15.2%) enrolled into an OCR program. OCR enrollment rates were significantly higher among PN participants (n=21, 23.6%) compared to UC participants (n= 6, 6.7%; p = 0.001). Two adjusted logistic regression models showed that participants in the intervention arm were three times more likely to enroll in OCR (Model 1: p=0,024 and Model 2: p=0.018). No other variables were associated with OCR enrollment. • Conclusions: Although still suboptimal, OCR enrollment rates within 3 months of hospitalization were significantly higher among patients assigned to navigation compared to UC. More research is warranted to test PN as an evidence-based strategy to increase utilization of OCR, especially among underrepresented groups such as women and minorities • Correspondence: Lisa Benz Scott, lbenzscott@notes.cc.sunysb.edu • The results reported here represent preliminary analyses of the first • 114 consented patients in the trial. • These early findings are encouraging, that an innovative Cardiac • Patient Navigation program, implemented in a real world hospital • setting, can significantly improve rates of OCR enrollment among • clinically eligible patients in a suburban community that has • access to OCR programs locally. • Despite the burden of cardiovascular disease and the • preponderance of evidence in support of OCR participation for • secondary prevention, this intervention research is one of few studies • to target improvements in OCR access and use. • More behavioral intervention research is needed to test strategies • that will reduce modifiable barriers to OCR participation, especially • among underrepresented groups (women, racial/ethnic minorities). • INTERVENTION DESCRIPTION • Cardiac Patient Navigators are trained peer helpers who provide the intervention group: • Face-to-face education during hospitalization about the role of • cardiac rehabilitation in recovery • Telephone-based support and informational mailings up to • 3 months after hospital discharge to assist patients with: • scheduling post-discharge appointment with physician • obtaining physician referral to cardiac rehabilitation • contacting OCR program staff at facility chosen by patient • to assist with scheduling an initial visit • Navigators keep a log to document all patient encounters • USUAL CARE • SBUH is a large 500+ bed tertiary care facility with a state of the art Heart Center that discharges over 3,000 cardiac patients per year. Study participants who are assigned to UC receive standard discharge instructions. Physician referral to OCR prior to discharge and telephone-based support post-discharge are not standard practice at SBUMC. Patients typically find out about the availability of OCR on their own or during a post-discharge follow-up appointment with a cardiologist or other provider, if at all. There are at least 5 OCR programs available near SBUH. • DATA COLLECTION & MEASURES • Inpatient chart review/self-report: sociodemographic & clinical characteristics, health system (insurance, inpatient CR) • Other self-report measures included: • Depression (CES-D, Radloff et al., 1977) • Functional Status (SF-36, Ware et al., 1992) • Comorbidities (Charleson Comorbidity Index, Charlson, 1987) • OCR enrollment (having attended > 1 OCR session): • attendance confirmed by 5 collaborating OCR programs P = 0.001 ACKNOWLEDGEMENT Lisa Benz Scott and David L. Brown are Co-Principal Investigators on the trial reported here, supported in part by NIH GCRC Grant #MO1RR10710, and a Targeted Research Opportunity with contributions by the Schools of Medicine (Cardiology) and Health Technology and Management, SBU. Thomas R. Sexton is the statistician and a Co-Investigator for this project. We would like to thank the GCRC and the Center for Survey Research, our Navigators Ms. Tina Manning and Fay Wright, and Project Coordinator Mrs. Frances Shaw for their dedication. We also thank the patient volunteers. Analyzed