Our overarching goal is to increase enrollment, adherence and completion of cardiac and pulmonary
rehabilitation (CR/PR) in a diverse population of low socioeconomic status; thus we will use a multi-pronged
approach to increase referral, enrollment, adherence and completion. Our objectives are to 1) implement an
EHR-based approach to increase referral to CR/PR, 2) evaluate the effect of choice of hospital or home-based
rehabilitation on enrollment, adherence and completion and 3) evaluate the effect of nudge messaging on
adherence and completion. This single site trial will be performed at Denver Health Medical Center, a large
urban integrated safety net health system. We will provide all patients with the cellphone-based application,
Movn, which will be used to deliver home-based rehabilitation and nudge messaging among patients
randomized to those arms.
In year 1 (R61 phase), we will 1) implement EHR-based interventions, 2) conduct a series of N of 1 trials to
refine the nudge messages and tailor the interventions for diverse audiences, including Spanish-speaking
patients, and 3) develop a one-page tool to present information, pros and cons of hospital and home-based
rehabilitation for those randomized to choice. We will engage patients, providers, and health administrators to
provide feedback on the messages and the information sheet, as well as engaging them in routine feedback
during the study to help address potential barriers to implementation and help ensure sustainability. In the
latter half of year 1, we will begin enrollment in the Phase II randomized trial.
In years 2-5 (R33 phase), among patients eligible for CR or PR, we will conduct a patient level 2x2
randomized trial comparing: 1) hospital-based CR/PR and Movn alone; 2) hospital-based CR/PR and Movn
with nudge messaging; 3) choice of hospital or home-based CR/PR and Movn alone; and 4) choice of
hospital or home-based CR/PR and Movn with nudge messaging. The primary outcomes will be enrollment,
adherence and completion of CR/PR. The study will also be evaluated using the RE-AIM framework.