S-95 The implications of COVID-19 on cardiac rehabilitation: The need for theory-driven, telehealth-enhanced, non-traditional models

Document Type

Conference Proceeding

Publication Date

5-1-2021

Publication Title

Implementation Science

Abstract

Background: Using a theory-driven approach, we sought to determine the best model for cardiac rehabilitation (CR) delivery in the post-COVID-19 era of remote clinical care. Methods: When clinic-based CR services ceased (March-May 2020), we conducted key informant interviews as part of a New York Presbyterian Hospital (NYPH) quality improvement initiative via Zoom/phone-call with CR supervisors (n=3) at major academic medical centers (New York, California, Michigan) and staff members (n=4)/health system leaders (n=2) affiliated with NYPH. Utilizing the Theoretical Domains Framework and the Consolidated Framework for Implementation Research, we assessed organizational-, provider-, and patient-level determinants of clinic- and home-based CR implementation during COVID-19, before eliciting suggestions on how best to design a remotely-delivered CR model. Findings: For clinic-based CR, external policies (e.g., social-distancing), infrastructure/available resources (e.g., limited space), emotion (e.g., patient discomfort/fear of in-hospital services; provider redeployment/burnout), and relative priority (e.g., safety over clinic-based CR) were key determinants of implementation during COVID-19. For home-based CR, external policies (e.g., reimbursement), available resources (e.g., staff capacity; telehealth services/devices; exercise equipment), cost (e.g., limited hospital budget), knowledge/skills/beliefs about capabilities (e.g., unfamiliarity with home-based CR/telemedicine; usability; language/communication), decision processes (e.g., triaging patients), and beliefs about consequences (e.g., patient safety) were key barriers; facilitators included collaborating with CR/telehealth champions/opinion leaders, engaging leadership and leveraging existing EHR/telemedicine infrastructure, and intervention adaptability. Informed by our results, we co-designed a telehealth-enhanced hybrid CR model with the potential to uphold CDC COVID-19 guidelines, align with NYPH telehealth initiatives, promote patient-provider communication, and permit reimbursement. The hybrid design combines home-based CR (e.g., remote exercise monitoring) with NYPH’s existing clinic-based CR and EHR/MyChart (e.g., video visits) infrastructure to offer 24 CR sessions (4 clinic-based, 20 home-based) over 12 weeks. This model is currently being pilot tested among low-risk cardiac patients attending a NYPH CR clinic. Implications for D&I Research: This is the first study to employ theoretical frameworks to identify multi-level determinants of both clinic- and home-based CR implementation during COVID-19. Different barriers emerged for each CR model, supporting the need for a telehealth-enhanced hybrid CR program. Future research will provide vital knowledge on the effectiveness, feasibility, acceptability, and appropriateness of this hybrid model in the post-COVID era.

Volume

16

Issue

Suppl 1

First Page

1

Find It @ Sladen

Share

COinS