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Challenges to CR Referral and Enrollment at Lee Health

Lee Health, in Southwest Florida, is one of the largest not-for-profit public health systems in the United States, with four acute care and two specialty hospitals, over 14,000 employees, and three cardiac rehabilitation (CR) programs. With an automatic referral system already in place, Marion Harris-Barter, RN, BSN, M.Ed., CCRP, Lee Health System's Director of Cardiac Rehabilitation, identified two other challenges to boosting CR participation: (1) the failure of some physicians to make referrals to CR and (2) the problem of patients who were referred but never enrolled.

Championing Improvements in Care Coordination

As Lee Health's TAKEheart champion, Ms. Harris-Barter found the opportunity to learn from other hospitals about how they addressed problems like these to have been especially valuable. To address referral failures, Harris-Barter and Lee Health adopted a strategy described by another TAKEheart hospital of reaching out to physicians who were failing to refer their patients. She also worked with her IT team to set up physician reminders through the EHR to submit referrals on patients that were missed due to order sets that did not trigger the referral.

To improve enrollment of referred patients, Harris-Barter's team realized the importance of maximizing contact and education with patients while they were in the hospital. Using TAKEheart care coordination guidance and materials, the team developed an informational handout to give to all patients prior to discharge. It describes the benefits of CR, services provided, frequency of sessions, and related topics. Lee Health also added a follow up with patients who missed the scheduled CR orientation.

Next Steps

Lee Health continues working to better understand the most significant barriers to CR enrollment. Harris-Barter and her team are committed to improving enrollment and adherence in the program by tracking data and following up with patients who are missing sessions. Harris-Barter is pleased with the progress of CR engagement by both physicians and patients, and attributes Lee Health's improved care coordination processes to their participation in TAKEheart.