Improving cardiac rehabilitation attendance and completion through quality improvement activities and a motivational program

Quinn R. Pack, Lezlie L. Johnson, Laurie M. Barr, Stephanie R. Daniels, Anne D. Wolter, Ray W. Squires, Carmen M. Perez-Terzic, Randal J. Thomas

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations


PURPOSE: Recent studies have demonstrated that patients who attend more cardiac rehabilitation (CR) sessions have lower subsequent mortality rates than those who attend fewer sessions. METHODS: We analyzed the impact of several phased-in policy and process changes implemented to increase patient participation in CR. In March 2010, our CR program changed from a policy of individualizing the recommended number of CR sessions per patient to a policy that recommended all 36 CR sessions. In October 2010, we introduced a 7-minute video describing the benefits of CR. In August 2011, we introduced a motivational program that rewarded patients after every sixth CR session. The number of CR sessions attended was determined through review of billing records. Enrollment and completion were defined as attending ≥1 session and ≥30 sessions, respectively. RESULTS: We identified 1103 patients sequentially enrolled in CR between May 2009 and January 2012. Overall, the median number of sessions per patient improved from 12 to 20 (P <.001). Completion rate improved from 14% to 39% (P <.001). The motivational program increased attendance by a median of 3 sessions per patient (P =.04), but this effect was limited to local CR participants. Financial analysis suggested that for every $100 spent on motivational rewards, patients attended an additional 6.6 (95% CI,-1 to 14) sessions of CR. CONCLUSIONS: Quality improvement activities significantly increased CR participation. Wide implementation of such programs may favorably impact patient participation in CR and potentially decrease the rate of subsequent cardiac events.

Original languageEnglish (US)
Pages (from-to)153-159
Number of pages7
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number3
StatePublished - May 2013


  • adherence
  • cardiac rehabilitation
  • completion
  • participation
  • quality improvement

ASJC Scopus subject areas

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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