Improving Veteran Referral to Cardiac Rehabilitation

Официальное название

Improving Veteran Referral to Cardiac Rehabilitation: A Hybrid Effectiveness-Implementation Trial

Обзор

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.

Подробное описание

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.

Вмешательства

• Поведенческое Veterans 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.

Первичные конечные точки

• Cardiac rehabilitation referral [Срок оценки: From hospital admission to 30 days after discharge]

Вторичные конечные точки (1)

• Cardiac rehabilitation initiation [Срок оценки: Within 6 months of hospital discharge]

Критерии участия

Критерии включения

• 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).

Критерии исключения

• No exclusion criteria during the intervention period

• however, post-hoc analysis will exclude Veterans with documented reasons preventing CR attendance including death during hospitalization or within 30 days of discharge, discharge to inpatient rehabilitation or skilled nursing facilities, significant cognitive impairment, high-risk ventricular arrhythmias, or explicit refusal of CR services.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Организация здравоохранения

Центры проведения

США · 3 центра

• North Florida/South Georgia Veterans Health System, Gainesville, FL — Gainesville
• Tennessee Valley Healthcare System Nashville Campus, Nashville, TN — Nashville
• VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX — Dallas

Идентификаторы

NCT: NCT07079358 · IIR 23-171

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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