(Ades et al, 2017).

Cost
Cardiovascular disease costs  over $200 billion per year in U.S. alone  (Widmer, 2017). 

2012 acute MI hospitalization w/ LOS average 4.6 days costs greater than $72, 000 . Non-monetary cost-->in hospital death rate of 5.16%.  (Thomas et al., 2018).

2012 greater than 500,000 patients with heart diseases treated in hospital with mean LOS 3.7 days and associated charges approaching $69,000 (Thomas et al., 2018)

CR decreases recurrent MI and mortality rates, improves patients QOL, and ability to return to work more quickly. Participation associated with 20-30% reduction in hospital readmission during the year after CV event (Thomas et al., 2018)

Plan : Implement strategies known to effectively increase referral and enrollment rates in Cardiac Rehab

Do:
1)Start a home-based cardiac rehabilitation option (longer timeline given need for program development and training)
2) implement automatic inpatient CR referral system ( initiate ASAP )
3)secure  early CR appointment prior to patient discharge  ( initiate ASAP )

Study:
Did referral to CR increase with these systems in place ?
Did enrollment and participation rates in CR increase?
Did health outcomes improve as evidenced by decreased hospital readmission and decreased morbidity and mortality?

Act:
Expand initiatives to all center-based cardiac rehabs in WNY if referral and participation rates increase. Share data nationally and with payers to start discussion about  benefits and coverage for home-based CR delivery model 

(Ades et al, 2017).

Integrated Delivery Systems (IDS)
Definition: Network of organizations that provides or arranges to provide a continuum of services to a defined population and that is willing to be held clinically and fiscally responsible for the outcomes and health status of the population
Participants: physicians, hospitals, insurers
Objective: have one organization deliver range of services 

(Shi & Singh, 2017)