Using default options to increase referral to cardiac rehabilitation


Cardiac rehabilitation has been demonstrated to reduce mortality by up to 30% in high-risk cardiovascular patients. However, less than 33% 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 worked with the Penn Medicine Heart and Vascular service line to redesign the referral process by changing defaults from opt-in to opt-out. This included automating the identification of eligible patients, delivering real-time notifications to frontline providers and restructuring processes associated with both rounds and discharge. Eligible patients are now referred to a cardiac rehabilitation program by default unless the cardiologist opts out.


In this study, the intervention led to a significant 47 percentage point increase in cardiac rehab referral compare to the control group.  At the intervention hospital, referral rates were about 15% before the intervention and 85-90% after it was implemented. This rates were sustained in the two years of follow-up.


Penn Medicine Heart and Vascular Center

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