A Brief Description of the Stanford Cardiac Rehabilitation Program
The Stanford Cardiac Rehabilitation Program is a research unit within the Cardiovascular Medicine Division of the Department of Medicine within the Stanford University School of Medicine. During its 33-year existence, beginning in 1974, the research conducted by SCRP has been supported by Federal, foundation and other non-profit sector grants and industry-sponsored grants. The total amount of this support, including University indirect costs, has been approximately $28 M.
In 1996, Stanford University granted an exclusive license to use a care management system for chronic disease developed by SCRP called MULTIFIT to a disease management company currently known as Matria HealthCare, but known at the time as Ralin Medical, Inc. and later CorSolutions.
In addition to the licensing fees, the firm made Directed Research Grants to Stanford University of more than $1 M to support the testing and expansion of the MULTIFIT system by SCRP.
MULTIFIT, now in wide use in the Kaiser Permanente healthcare system, has achieved results similar to those achieved during the Stanford-Kaiser research collaboration that established the efficacy of MULTIFIT.
Stanford University has retained the rights to MULTIFIT.
The SCRP has now developed a second care management system, the Stanford Chronic Care Management System, which is provides telephone triage and followup to enrolled patients with established coronary artery disease who experience recurrent cardiovascular symptoms.
The SCRP has always operated as a non-profit entity with the support of research grants to Stanford University. SCRP wishes to continue this tradition.
An organizing principle of the research is that any clinical trials conducted by the SCRP designed to test or refine the elements of SCCMS are conducted under the aegis of the Committee on Human Subjects at Stanford University. This arrangement is essential to the protection of one of the chief assets of SCRP: adherence to the high standards of safety and objectivity established by the Committee, including the obligation to disclose any untoward effects of the interventions on patients and to publish the results of the research in high-quality peer-reviewed journals.
There are 3 major principles that guide the dissemination research conducted by SCRP:
- The clinical outcomes observed in patients receiving the SCCMS intervention (ER and rehospitalization rates, etc.) are systematically compared with outcomes documented in cohorts of clinically similar patients not receiving SCCMS. This permits evaluation of the safety and efficacy of SCCMS.
- The costs of providing SCCMS to patients, termed program costs, are measured systematically. These costs reflect primarily personnel costs to permit the SCCMS staff to maintain and establish ongoing telephone contact with patients and physicians. Additional program costs are those associated with acquiring baseline data required to establish the database and followup data regarding clinical outcomes and satisfaction of patients and physicians. The costs of adapting the database application developed by SCRP to the needs of individual partners represent additional program costs.
- The medical care costs (rehospitalizations, ER visits, coronary revascularizations, etc.) incurred by patients enrolled into SCCMS are systematically compared with those of patient cohorts that do not participate in SCCMS. These data help to establish the potential cost reductions achieved by SCCMS and the potential net savings associated with the use of SCCMS.
These elements of the SCRP approach to research help not only to establish the scientific validity of the research, but the feasibility of achieving comparable results in a variety of clinical venues.
Robert F. DeBusk, MD, is Professor of Cardiovascular Medicine at the Stanford University School of Medicine, at Stanford, California. He was educated at Stanford and Harvard Universities. In 1973 he founded and continues to direct the Stanford Cardiac Rehabilitation Program, a research program devoted to the development of integrated systems for chronic disease management.
Nancy Houston Miller, RN, BSN, is the Associate Director of the Stanford Cardiac Rehabilitation Program and adjunct clinical assistant professor at the University of California San Francisco (UCSF) School of Nursing and the Johns Hopkins School of Nursing. She attended the University of Washington School of Nursing where she obtained her Bachelor of Science Degree in Nursing.
Lynda Raby is the Operations Coordinator of the Stanford Cardiac Rehabilitation Program. She has been on the SCRP team for the past 25 years.
