Project Title: Implementing a Cardiac Rehabilitation Telehealth Program to Improve Access and Outcomes
Background: Cardiovascular disease is the leading cause of death in the United States. Regular participation in cardiac rehabilitation (CR) programs after a cardiac event has been shown to significantly reduce mortality and hospital readmissions while improving quality of life. Despite the documented benefits, nationally only 15-30% of eligible patients complete a CR program. Barriers to participation include lack of accessible programs, transportation difficulties, costs, and work or family constraints. Telehealth offers an innovative solution to expand access by allowing remote monitoring and participation in CR. More evidence is still needed on the efficacy and best practices of telehealth-based CR.
Project Goals: The goals of this capstone project are to:
1) Implement a telehealth-based CR program allowing remote participation and monitoring for patients at my clinic who are unable to attend onsite sessions.
2) Evaluate the impact of the telehealth CR program on outcomes including program adherence/completion rates, readmission rates, quality of life, and cardiac risk factors after 6 months.
3) Identify best practices and lessons learned from implementation to refine the telehealth CR program.
Methodology: This project will follow a quality improvement framework. In the planning phase, I will conduct a comprehensive literature review on telehealth-based CR. I will identify an evidence-based telehealth platform and prototype virtual sessions. In collaboration with CR nurses, exercise physiologists, and an IT specialist, we will develop protocols for remote monitoring, exercise prescriptions, education modules, and technical/user support.
In the implementation phase, I will train the CR team on the telehealth program. We will enroll 30 English and Spanish-speaking patients referred to CR but unable to attend onsite. Written consent will be obtained to participate and be evaluated. At baseline and 6 months, I will collect data on clinical variables, quality of life (Minnesota Living with Heart Failure and Short Form-36 surveys), and program usage/satisfaction through interviews. Virtual sessions will include exercise training, education on lifestyle/medication management, and peer/staff support twice weekly for 6-12 weeks. Continuous remote monitoring tools will track activity, vital signs, weight, and symptoms.
In the evaluation phase, I will analyze clinical and survey outcomes to assess the impact of telehealth CR compared to usual care. Readmission rates will be obtained from medical records. Patient interviews will identify barriers/facilitators. Using a predetermined analytic plan, I will evaluate if telehealth improved adherence rates by at least 10% and reduced readmission rates by 5% compared to usual care. If successful, qualitative findings will help determine best practices to refine and disseminate the program model. Limitations, unexpected findings, and implications for future research will also be discussed.
Anticipated Outcomes: This innovative capstone project has the potential to demonstrate telehealth is an effective strategy for increasing CR access and participation among underserved patients. If telehealth CR improves outcomes compared to usual care, it could serve as an evidence-based model for wider implementation. By addressing barriers and promoting remote support, more patients may experience the life-saving benefits of rehabilitation after a cardiac event. This work aligns with my goals as a cardiology nurse to advance quality, equitable care through application of research and technologies.