Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients.

Abstract

Background Cardiac rehabilitation (CR) is a guideline-recommended therapy that improves outcomes in cardiovascular disease, yet referral at hospital discharge remains suboptimal. Project rationale Variability in discharge workflows and inconsistent use of standardized referrals contributed to missed CR referrals among eligible patients. Project summary We implemented an electronic health record (EHR)-based best practice advisory within the Epic EHR system to prompt CR referral or documentation of nonreferral reasons for guideline-eligible cardiovascular patients. A retrospective quality improvement study compared preimplementation (February 1, 2022-January 31, 2024) and postimplementation (February 1, 2024-January 31, 2026) cohorts (N = 21,294). Outcomes assessed included CR referral orders, documentation of referral activity, and CR-related activity. CR referral rates increased from 45.3% to 86.7% after best practice advisory implementation. Take-home messages EHR-based decision support improved CR referral rates among guideline-eligible patients by integrating referral prompts into discharge workflows. Continued optimization of provider engagement and workflow integration may further improve referral completion.