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Default Opt-Out of Cardiac Rehabilitation Increases Referrals

TUESDAY, Jan. 19, 2021 -- For inpatients with ischemic heart disease, redesign of decision pathways from default opt-in to opt-out of cardiac rehabilitation (CR) results in a significant increase in CR referrals, according to a research letter published online Jan. 14 in JAMA Network Open.

Srinath Adusumalli, M.D., M.S.P.H., from the University of Pennsylvania Health System in Philadelphia, and colleagues examined changes in CR referral after automated electronic health record-based technology was used to identify eligible patients and decision pathways were changed from opt-in to opt-out referral. A difference-in-differences analysis was performed to evaluate changes in CR referral rates at an intervention site versus two control sites during a one-year preintervention period and two-year postintervention period. Data were included for 2,832 patients with ischemic heart disease from three hospital sites.

The researchers observed no difference between the intervention and control sites in preintervention trends. The percentage of CR referrals was 85.7 percent at the intervention sites and 31.6 percent at the control sites at the end of the study. The intervention site had a significant 47-percentage point increase in CR referrals compared with control sites over time.

"Restructuring decision pathways from an opt-in to an opt-out choice was associated with a significant increase in CR referrals," the authors write. "This pathway represents a low-cost, scalable approach that could be expanded to other health systems and for other therapies."

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