Cardiac Rehabilitation, Cardiovascular Disease
Conditions
Keywords
Cardiac Rehabilitation, Hybrid Effectiveness-Implementation Trial
Brief summary
This study will test whether the Veterans Cardiac Rehabilitation Referral Program (VCR2P) improves cardiac rehabilitation participation by studying 816 Veterans across three VA medical centers in Nashville, Dallas, and Gainesville over 12 months. The trial compares referral rates from the 6 months before implementing the program to 6 months after, using a "before and after" design since randomization would be impractical. The study will measure whether the program increases the proportion of eligible Veterans who receive cardiac rehabilitation referrals and whether more Veterans actually attend rehabilitation sessions. Additionally, focus groups with physicians, nurses, and Veterans will identify what helps or hinders the program's success, providing essential insights for expanding this intervention to other VA facilities nationwide if it proves effective.
Detailed description
This study seeks to evaluate the Veterans Cardiac Rehabilitation Referral Program (VCR2P) using a type 2 hybrid effectiveness-implementation design. The trial involves a single-arm, pre-post trial at three VA medical centers, enrolling a total of 816 Veterans who are eligible for cardiac rehabilitation (CR). The primary objective is to assess the program's impact on two key outcomes: CR referral rates and CR initiation rates. Secondary implementation outcomes will include measures such as reach, adoption, fidelity, maintenance, and cost, providing a comprehensive understanding of how the intervention performs in real-world VA settings. This evaluation will be guided by implementation science frameworks to ensure the program is scalable and sustainable. A summative evaluation will be conducted to inform broader implementation across the Veterans Health Administration. The goal is to determine not only whether VCR2P improves referral and participation in CR but also how it can be feasibly integrated into routine care to close quality gaps and enhance cardiovascular outcomes for Veterans.
Interventions
BEHAVIORALVeterans Cardiac Rehabilitation Referral Program
1. A CDS tool that identifies Veterans hospitalized with CR-eligible conditions and prompts physicians to refer them to CR. 2. Educational materials that explain to Veterans the benefits and importance of participating in CR. 3. Defined responsibilities for a facility-based CR referral coordinator who will support development and oversight of the referral process.
Sponsors
VA Office of Research and Development
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
A single-arm, pre-post intervention study comparing cardiac rehabilitation referral rates 6 months before and 6 months after implementing the Veterans Cardiac Rehabilitation Referral Program (VCR2P) at three VA medical centers.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All Veterans hospitalized with acute myocardial infarction, percutaneous coronary intervention, cardiac valve surgery, coronary artery bypass grafting, or systolic heart failure at the three participating VA medical centers (Nashville, Dallas, and Gainesville).
Exclusion criteria
* No
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac rehabilitation referral | From hospital admission to 30 days after discharge | Proportion of eligible Veterans referred to cardiac rehabilitation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac rehabilitation initiation | Within 6 months of hospital discharge | Proportion of eligible Veterans attending at least one cardiac rehabilitation session. |
Countries
United States
Contacts
CONTACTJustin M Bachmann, MD MPH
CONTACTRay Stokes Peebles, MD
PRINCIPAL_INVESTIGATORJustin M Bachmann, MD MPH
Tennessee Valley Healthcare System Nashville Campus, Nashville, TN
Outcome results
None listed