Using default options to increase referral to cardiac rehabilitation


Cardiac rehabilitation has been demonstrated to reduce mortality by up to 30 percent in high-risk cardiovascular patients. However, less than 33 percent of eligible patients participate in a formal program. Health systems often struggle to effectively refer eligible patients, which contributes to low participation rates. At Penn Medicine, we found that cardiologists had to manually identify eligible patients during their busy inpatient rounds and opt-in to refer them to cardiac rehabilitation.


We partnered with the Penn Medicine Heart and Vascular Center to redesign the referral process. To start, we changed the default from opt-in to opt-out so that patients were referred to a cardiac rehabilitation program unless the cardiologist opted out. Next, we automated the identification of eligible patients, delivered real-time notifications to frontline providers, and restructured processes associated with both rounds and discharge.


Our intervention led to a 47 percentage point increase in cardiac rehabilitation referral compared to the control group. At the intervention hospital, referral rates were about 15 percent before and 85 to 90 percent after, rates that sustained in the two years of follow-up.


Penn Medicine Heart and Vascular Center

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