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Regime is customized for each patient
Faced with sending its cardiac patients across town for rehabilitation, a network of provid ers opened its own cardiac rehabilitation center with services emphasizing prevention and exercises that can be done easily at home.
The Einstein Cardiac Rehab and Fitness Center is a combined effort of MossRehab, Albert Einstein Heart Center, and Germantown Hospital and Community Health Services, all part of the Albert Einstein Healthcare Network in Philadelphia.
The center was opened in the summer of 1998 to serve patients recovering from heart-valve surgery, angioplasty, heart attacks, coronary artery bypass, heart failure, stable angina, and other heart conditions and procedures.
Instead of a structured exercise program using resistance machines, the Einstein Cardiac Rehab and Fitness Center focuses on preventing future heart problems.
"With shared-risk contracts, everybody has a stake in preventing second heart attacks through long-term management of risk factors such as smoking, diabetes, and cholesterol management," says Lance Crosby, RN, MA, director of the Einstein Cardiac Rehab and Fitness Center.
The cardiac rehab services include an individualized exercise and education program for each patient. "We try to make it a unique experience for them based on their own rehabilitation and education needs," Crosby says.
Treadmill walking is the primary exercise modality used at the Einstein center because it gives the patients a form of exercise they can do at home without purchasing a machine, he says. "Bikes, rowing machines, and other exercise machines do the job, but humans are primarily a walking machine. I want my patients to be able to leave here and do regular walking as their principal source of exercise."
For the same reason, Crosby uses dumb bells for resistance training rather than machine weights. "My patients can go out for a walk every day and put weights in their bedroom and do exercises with them twice a week. We try to accentuate transference to home activities," he says.
Patients at the Einstein Center go through a one-on-one education program based on nutrition and diet modification, with the objective of getting them down to a diet that includes about 15% of calories from fat.
Patients are asked for a diet history, what foods they normally eat, and whether they eat out or cook at home. Staff help them learn to adapt their current eating methods for a diet. "If they love meatloaf, we help them find a way to change the meatloaf. With the ethnically diverse population we serve, it doesn’t make sense to hand out standard diets," Crosby says.
The program is staffed by Crosby, who is a registered nurse and an exercise physiologist, along with another nurse and a certified diabetic educator.
"Other than nutritional education, diabetic education is the most formalized education our patients receive. Both require a significant amount of discipline," he says.
When a patient is referred to the program, Crosby conducts an initial evaluation free of charge and recommends a treatment plan. He then contacts the patient’s insurer to find out if the services will be covered and to what extent. "As a service to the payers, we try to minimize the amount of insurance utilization so we provide value to the insurance company," he says.
For instance, if an insurer agrees for the patient to attend 36 sessions and Crosby feels the patient has accomplished his or her goals in 20 sessions, the center discharges the patient. "We don’t try to maximize insurance utilization. There is a price to pay for that in the long run," he says.
Patients generally come to the program for a one-hour session three times a week. Crosby uses the first few sessions to get to know the patients and teach them how to operate the equipment. Spouses often attend the early sessions. The number of sessions varies depending on the patient, with the average being 18.
Crosby is evaluating outcomes measures to decide which ones meet the objectives of his program. (For more information on cardiac rehab outcomes measures, see Rehabilitation Outcomes Review, p. 33.)