Developing an operational framework for hybrid cardiac rehabilitation in a safety-net healthcare system

Cardiac rehabilitation (CR) remains substantially underutilized despite its well-established clinical benefits. Hybrid models that combine in-person and virtual care have emerged as a promising strategy to improve access; however, practical guidance describing how these programs can be developed within safety-net healthcare systems remains limited. To expand access to CR, Rancho Los Amigos National Rehabilitation Center developed a hybrid program informed by published evidence, an internal review of existing CR services, and a patient needs assessment among individuals referred to the program. The assessment identified geographical distance, transportation, and scheduling conflicts as the primary barriers to participation while demonstrating broad access to smartphone technology capable of supporting video-based care. Program findings informed the development of an operational framework and accompanying program manual to support consistent delivery of hybrid CR. The approach described here may provide practical guidance for other healthcare systems seeking to expand CR availability through hybrid care models.