Costs of Cardiac Care: Patient Burden and Rehabilitation Delivery

Simple item page
dc.contributor.advisorGrace, Sherry L
dc.contributor.authorMoghei, Mahshid
dc.date.accessioned2019-11-22T18:55:24Z
dc.date.available2019-11-22T18:55:24Z
dc.date.copyright2019-07
dc.date.issued2019-11-22
dc.date.updated2019-11-22T18:55:23Z
dc.degree.disciplineKinesiology & Health Science
dc.degree.levelDoctoral
dc.degree.namePhD - Doctor of Philosophy
dc.description.abstractBackground: Cardiac rehabilitation (CR) reach is minimal globally, primarily due to financial factors. This study characterized CR funding sources, cost to patients to participate, cost to programs to serve patients, and the drivers of these costs. Methods: In this cross-sectional study, an online survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Costs in each country were reported using purchasing power parity (PPP). Results were compared by World Bank country income classification using generalized linear mixed models. Results: 111/203 (54.68%) countries in the world offer CR, of which data were collected in 93 (83.78% country response rate; N=1082 surveys, 32.0% program response rate). CR was most-often publicly funded (more in high-income countries [HICs]; p<.001), but in 60.20% of countries patients paid some or all of the cost. Funding source impacted capacity (p=.004), number of patients per exercise session (p<.001), personnel (p=.037), and functional capacity testing (p=.039). The median cost to serve 1 patient was $945.91PPP globally. In low and middle-income countries (LMICs), exercise equipment and stress testing were perceived as the most expensive delivery elements, with front-line personnel costs perceived as costlier in HICs (p=.003). Modifiable factors associated with higher costs included CR team composition (p=.001), stress testing (p=.002) and telemetry monitoring in HICs (p=.01), and not offering alternative models in LMICs (p=.02). Conclusions: Too many patients are paying out-of-pocket for CR, and more public funding is needed. Lower-cost delivery approaches are imperative, and include walk tests, task-shifting, and intensity monitoring via perceived exertion.
dc.identifier.urihttp://hdl.handle.net/10315/36781
dc.languageen
dc.rightsAuthor owns copyright, except where explicitly noted. Please contact the author directly with licensing requests.
dc.subjectHealth care management
dc.subject.keywordscardiac rehabilitation
dc.subject.keywordscardiovascular disease
dc.subject.keywordsglobal health
dc.subject.keywordscost
dc.subject.keywordshealth economics
dc.titleCosts of Cardiac Care: Patient Burden and Rehabilitation Delivery
dc.typeElectronic Thesis or Dissertation

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Moghei_Mahshid_2019_PhD.pdf
Size:
3 MB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 2 of 2
No Thumbnail Available
Name:
license.txt
Size:
1.87 KB
Format:
Plain Text
Description:
Download
No Thumbnail Available
Name:
YorkU_ETDlicense.txt
Size:
3.39 KB
Format:
Plain Text
Description:
Download

Collections

Kinesiology & Health Science

All items in the YorkSpace institutional repository are protected by copyright, with all rights reserved except where explicitly noted.