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Penn Presidential Engagement Prize Winner Leads the Way

As an undergraduate student, Jodi L. Feinberg, Nu’15, RN, BSN came face-to-face with a startling statistic: Only 14 percent of patients who have a heart attack attend outpatient cardiac rehabilitation programs even though the patients who receive cardiac rehab stay healthier and are better able to avoid hospitalization. Feinberg wondered if developing a program that increased accessibility to cardiac rehab would result in better outcomes.

“I wanted to increase access to the benefits of cardiac rehab through an alternate delivery model that would help elderly, homebound patients. As a nurse, I realized I could improve patient care if I understood the system and advocated to improve it,” she explains.

With mentorship from Terri Lipman, PhD, CRNP, FAAN, Mirian Stirl Endowed Term Professor of Nutrition, Professor of Nursing of Children and Assistant Dean for Community engagement, Feinberg developed “Home, Heart, Health (HHH): Engaging the Community in Bridging the Gap,” a comprehensive home-based cardiac rehabilitation model. Her project netted one of the four awards from the inaugural President’s Engagement Prize.

“The President’s Engagement Prize is truly a once-in-a-lifetime opportunity to change the world,” says Feinberg.

The $100,000 prize allowed Feinberg to implement her pilot program in partnership with New York University Langone Medical Center (NYULMC) and the Visiting Nurses Services of New York (VNSNY). Prior to launch, Feinberg interviewed patients to better understand their needs. “I was surprised that many patients didn’t understand why they were hospitalized,” she says. “It’s unrealistic to expect patients to manage their disease independently when they lack awareness of their heart condition”. Further, patients said they could not attend outpatient rehab because of physical limitations, transportation issues and socioeconomic barriers. Feinberg proposed increasing access to cardiac rehab by modifying cardiac rehab services for the home-care setting.

Feinberg incorporated the patients’ input to develop a program and train interdisciplinary teams of registered nurses, physical therapists and occupational therapists to deliver the adapted cardiac rehab services. She created patient nutrition and exercise teaching tools for clinicians to use during visits.

During the pilot, 53 patients received an average of 11 visits from the teams over a one-month period. And the results were impressive: Patients’ symptoms, their ability to self-manage those symptoms and their decision-making markedly improved. Many reported making lifestyle changes and an increased awareness of their cardiac disease. “Of our patients, only 11 percent were readmitted to the hospital, while the national heart failure 30-day readmission rate is 24 percent,” says Feinberg.

Feinberg’s findings will be published in The Journal of Cardiopulmonary Rehabilitation and Prevention. She also will present her data at the national American Association of Cardiovascular and Pulmonary Rehabilitation meeting in New Orleans in September 2016. Once the data are disseminated nationally, there is the potential to impact the care of patients with cardiovascular disease nationwide.

Feinberg is currently employed on NYULMC Cardio Vascular Special Care Unit and additionally plans to conduct a larger study on the efficacy of homebased cardiac rehab. She continues to work with VNSNY, the country’s largest not-for-profit certified home health agency, to guide the clinicians who use her model and prepare for the expansion of the program.

Feinberg hopes the program made possible by the President’s Engagement Prize inspires others. “With Penn’s vision and support, anything is possible, so dream big,” she says. Together, we can impact healthcare’s evolving landscape and nursing can lead the way.”