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Cardiac Rehabilitation: The Role of Problem-Solving Competency in Adherence & Health Outcomes
Jillian Price, Ph.D., Outcomes Research Program and Functional Assessment Lab, Betty & Guy Beatty Center for Integrated Research, Inova Health System
Abstract: Per meta-analysis, early outpatient cardiac rehabilitation (CR) post cardiac procedure with completion of at least 25 or more sessions has shown ‘strong evidence of benefits’ on 8 major indices of health outcomes, including morbidity and mortality and every modifiable risk factor for cardiovascular disease. Despite great advances in knowledge and technique, even the most effective exercise-based rehabilitation interventions can become hobbled by lack of consistent participation, diminishing the benefits achieved by the participant. Current participation trends in cardiac rehabilitation are a clear illustration of this problem: presently, only 20%-34.7% (range 20.7% to 58.6% across 20 states) of those referred to cardiac rehabilitation actually attend sessions, and those attending often do not complete their full course of sessions, or attend inconsistently. No subgroup had utilization rates exceeding 50% and no state had utilization rates above 61%. This inconsistency of participation frequency, reduction in rehabilitation participation duration, and a decrease in overall number of session ‘doses’ of exercise accomplished have been linked with significantly poorer health outcomes.
Recently, the Department of Health and Human Service’s Million Hearts Initiative- a group of over 30 organizations and agencies- aimed to increase CR participation in heart attack survivors through a) increased referral to CR using electronic medical record-based referral, b) enrollment in rehab prior to hospital discharge, and c) improving adherence by minimizing patient co-payments. Per this initiative, ‘increasing use of cardiac rehab among patients with a qualifying condition’ to 70% or greater in 5 years would save an estimated 25,000 lives and prevent 180,000 hospitalizations annually in the United States, but success of this and other interventions targeting participation barriers to cardiac rehabilitation have been limited.
The pilot study discussed in this lecture aimed to examine a behavior-influencing factors, problem-solving competency, and their relationships with participation frequency and duration in cardiac rehabilitation, as well as their potential impact on health outcomes obtained from cardiac rehabilitation participation.
Biography: Dr. Jillian Price is a program manager and interdisciplinary researcher for the Outcomes Research Program and Functional Assessment Lab under the Betty & Guy Beatty Center for Integrated Research at Inova Health System, conducting research there since 2006. While at Inova she has conducted research in health-related quality of life, activity, diet, function and prevalence research within the context of a variety of chronic health conditions- chronic liver disease, autoimmune disease, and obesity. Prior to Inova, Jillian worked for a contract research organization as a data manager and protocol monitor for Phase III vaccine trials. Jillian has degrees in Biological Psychology (B.S.) and Health Psychology (M.S.), and Rehabilitation Science (Ph.D). Her additional research interests include biobehavioral interventions, cardiovascular function, non-alcoholic fatty liver disease, metabolism, healthy aging, and adherence. She is also a George Mason alumna.