Document Type

Report

Publication Date

Spring 2016

Date of Final Presentation

Spring 3-10-2016

Committee Chair

Sara Ahten, DNP

Committee Member

Jane Grassley, PhD

Optional Additional Committee Member

Pamela Strohfus, DNP

Coordinator/ Chair of DNP Program

Pamela Strohfus, DNP

Abstract/ Executive Summary

Cardiovascular disease (CVD) develops in the setting of poor health behaviors often secondary to hypertension, dyslipidemia and hyperglycemia or diabetes (Spring et al., 2013). In the United States, it is estimated that health care costs associated with CVD management will triple to $818 billion in 2030 (Spring et al., 2013). Cardiac rehabilitation (CR) is a secondary/ tertiary prevention program aimed at reducing modifiable risk factors for CVD in a patient population who has already experienced a “qualifying” cardiac event and may be at an increased risk for sustaining another, possibly life-threatening, event (Lucan, 2010). Existing evidence points to a 45-47% reduction in 10-year mortality for those patients who successfully graduate from CR programs by attending all 36 sessions (Goel, Lennon, Tilbury, Squires & Thomas, 2011; Pack et al., 2013). However, the majority of graduates do not remain compliant with learned health behaviors, thereby, forfeiting long-term benefits of such therapy, resulting in increased health care costs. The purpose of this evidence-based project was, initially, to evaluate the current evidence, but ultimately to drive a practice change, i.e. expand current Phase III services, to facilitate the sustainability of three health behaviors (physical activity, Mediterranean diet and medication adherence) in the Phase III (graduated) cardiac rehabilitation (CR) population at St. Luke’s Heart Health and Rehabilitation in Meridian (SLHHR), Idaho. Nineteen Phase III participants were enrolled in a six- month program. The program design provided participants with monthly, individualized health-coaching consultations conducted by a Registered Nurse (RN) as well as access to an exercise physiologist and the SLHHR CR facility. This pilot project utilized the SLHHR’s current Phase II patient education model, which is based on the Transtheoretical Model (Prochaska & DiClemente, 1983 and motivational interviewing (Miller & Rollnick, 2009; 2013). The outcome analysis demonstrates clinical significance in that the program contributed to lower readmission rates of cardiac patients as compared to the health system’s average 30-day cardiac readmission rate of 18% (Barnet, 2015) and sustainability of health behaviors among the group of participants. This improvement in outcome measures is anticipated to translate into a reduction in the utilization of acute care services and healthcare costs for the St. Luke’s Health System (SLHS).

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