Welcome to Part 2 of “What is Hybrid Cardiac Rehab?”, a 3 part series about this innovative model for the delivery of care. In Part 2, we will discuss the staffing commitment needed to incorporate Telehealth into a cardiac rehab program. There are 3 main tasks that Telehealth introduces to a CR workflow - patient onboarding, dashboard monitoring and video/telephone calls.

Patient onboarding
Patient onboarding is the process of setting up a patient’s home program and training them on how to use the mobile app. Onboarding involves an assessment of a patient’s ability to attend onsite sessions (patient classifications explained in Part 1 ), familiarizing the patient with the app and providing them with a home-based care plan.

Patient onboarding takes about 20 minutes per patient:

Dashboard monitoring
The provider side dashboard allows staff to monitor and assess patient’s data. Primary tasks while monitoring the dashboard include responding to chat messages sent from patients, resolving alerts generated by the dashboard, and viewing reports.

Once a patient has the app, the program staff can communicate with them via two-way chat. Patients are able to ask questions and voice concerns, which is very useful in avoiding an unnecessary emergency room visit. For a program with 300 patients it takes about an hour a day to monitor the dashboard and respond to messages or alerts.

Alerts can be sent to the dashboard when a patient’s vital signs are out of an acceptable range, if the patient is not adhering to their care plan including medications, or if new symptoms have been reported by the patient. Alerts are especially helpful in keeping CR staff updated with any significant changes that a patient may be experience during the time between their on-site visits or phone calls (see ‘Structured Phone Calls’ below).

Structured phone calls
As mentioned in Part 1, Type III patients receive coaching through structured weekly telephone or video calls. The goal of these coaching calls is for the staff to assess the patient’s adherence to the exercise prescription, discuss the education materials, provide emotional support and strategies to manage their CV risk factors. Each call typically takes 20 minutes, their frequency may change from month to month.

Telephone calls are structured as follows:

Upon completion of Hybrid CR, an exit interview is conducted to assess the patient, provide further direction if needed and to receive feedback on the program.

Training Staff
Staff will need technology training to be comfortable with the software needed for a Hybrid Cardiac Rehab Program. Programs should consider the use of support services during implementation. Program design, required staff training, EMR integration and billing and reimbursement are areas that may require support.

Implementing a Hybrid CR program typically takes one month but can vary as every program is unique. Cardiac Rehab Programs with large Type III populations may require additional clinical training for their nurses to coach Home-based Cardiac Rehabilitation participants. Clinical training for the home setting mitigates risk and will help patients progress optimally.

Conclusion
The Hybrid Cardiac Rehab model is ideal for programs experiencing barriers to increased program capacity. Budgetary constraints and/or lack of space for physical expansion can be overcome with this scalable and patient-centered care delivery model. The dashboard’s ability to streamline workflows, improve program performance measures and increase patient engagement, make it an essential tool for programs moving towards value-based care on a tight budget.

Hybrid CR is currently in use at Our Lady of Lourdes Medical Center (recently featured on ABC News), Northwest Community Hospital, Henry Ford Hospital, and is undergoing expansion to multiple VA Medical Centers after a successful pilot program at the Atlanta VA. This has been Part 2 of 3 of What is Hybrid Cardiac Rehab. Check out our other articles on Feats in Heartbeats, the official Moving Analytics blog, for more information from thought leaders in CR and methods for the optimization of CR processes.

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