Key result
EHR discharge advisory linked to ~41-point increase in cardiac rehabilitation referrals.
Why the study?
Cardiac rehabilitation referral at hospital discharge remains suboptimal due to variability in discharge workflows and inconsistent use of standardized referrals among eligible patients.
Does implementing an EHR-based best practice advisory at hospital discharge increase cardiac rehabilitation referral rates in guideline-eligible hospitalized cardiovascular patients?
Cohort (n=21,294)
No
Does implementing an EHR-based best practice advisory at hospital discharge increase cardiac rehabilitation referral rates in guideline-eligible hospitalized cardiovascular patients?
Embedding an automated best practice advisory into the EHR discharge workflow nearly doubled cardiac rehabilitation referral rates (from 45.3% to 86.7%) among eligible hospitalized cardiovascular patients.
Answers are grounded in this paper and cite their sources.
May support EHR alerts to boost cardiac rehabilitation referrals; hypothesis-generating and should not yet change practice.
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.
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Albayyaa et al. (2026) conducted a cohort in Guideline-eligible hospitalized cardiovascular disease requiring cardiac rehabilitation (n=21,294). Electronic health record (EHR)-based best practice advisory (BPA) in Epic prompting cardiac rehabilitation referral or documentation of nonreferral reasons at discharge vs. Preimplementation standard discharge workflow without standardized EHR prompts was evaluated on Cardiac rehabilitation referral rate at hospital discharge. Implementation of an Epic EHR-based best practice advisory at hospital discharge increased cardiac rehabilitation referral rates from 45.3% to 86.7% among 21,294 guideline-eligible patients.
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