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Chapter 2

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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  1. Chapter 2 The Cardiac Rehabilitation Continuum of Care

  2. 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

  3. Continuum Barriers • Shorter lengths of stay • Duration of CR services • Added services, programming • Staffing • Outcomes • Table 2.1

  4. Expanded Services • Risk Factor Intervention Programs • Education & Counseling • Additional Exercise Training • Special Populations

  5. 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.

  6. 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

  7. 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)

  8. 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

  9. Challenges Budget Cuts – limit varied staff Fewer exercise visits covered Opportunities Risk factor triage Internet supplements Telephone follow-up Outpatient Challenges & Opportunities

  10. Challenges Out-of-pocket expenses Logistics issues General inability to continue Opportunities Rehab. checkup day Telephone follow-up Maintenance Challenges & Opportunities

  11. 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

  12. 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

  13. Core Components – Figure 2.4 • Page 13 – 16.

  14. 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

  15. Rehab. Alternatives • Nurse case management telephone calls • Home exercise w/ transtelephonic monitoring • Computer guided programs • Intensive diet therapy & psychological counseling

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