Feature Article A Mixed Methods Evaluation of the Feasibility and Acceptability of an Adapted Cardiac Rehabilitation Program for Home Care Patients Jodi L. Feinberg, RN, BSN a, * , David Russell, PhD b , Ana Mola, PhD, RN, ANP-C c , Melissa Trachtenberg, BA b , Irene Bick, RN, MBA d , Terri H. Lipman, PhD, CRNP, FAAN a , Kathryn H. Bowles, PhD, RN, FAAN a, b a University of Pennsylvania, School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA,19104-6096, USA b Visiting Nurse Service of New York, Center for Home Care Policy & Research, 1250 Broadway 7th floor, New York, NY, 10001, USA c Care Transitions and Population Health Management, NYU Langone Health, 545 1st ave, New York, NY, 10016, USA d School of Nursing, Columbia University, 617 W 168th St, New York, NY,10032, USA article info Article history: Received 19 April 2017 Received in revised form 22 August 2017 Accepted 23 August 2017 Available online xxx Keywords: Geriatric nursing Home-care services Cardiac rehabilitation Cardiovascular diseases Secondary prevention abstract Home care clinicians have an opportunity to improve care for post-hospitalization patients with cardiovascular disease. This mixed methods study examined the feasibility and acceptability of an adapted cardiac rehabilitation (CR) program for the home care setting. Surveys measuring patient self-care and knowledge were administered to patients (n ¼ 46) at baseline and at 30-day follow-up. Semi-structured interviews were conducted with patients (n ¼ 28) and home care clinicians (n ¼ 11) at completion of the program. All survey indicators demonstrated a trend towards improvement, with a statistically significant increase in the self-care management subscale (p ¼ 0.002). Qualitative analyses identified three patient themes (self-awareness, nutrition, motivation) and three clinician themes (systematic approach, motivation, patient selection process). Incorporating CR into the home care setting proved to be a feasible and acceptable approach to increasing access to CR services among elderly patients. Ó 2017 Elsevier Inc. All rights reserved. Introduction Current healthcare reform encourages innovative ap- proaches to care, particularly for patients with cardiovascular disease (CVD), the leading cause of death in the United States. 1e 2 Cardiac rehabilitation (CR) utilizes exercise, education, coun- seling on behavioral change, risk factor modification, and psy- chosocial well-being to reduce morality and risk of hospital readmission. 3 However, only 13.9% of acute myocardial infarc- tion patients and 31.0% of coronary artery bypass graft surgery patients attend CR post-hospitalization, with very low atten- dance rates among heart failure patients as well. 4,5 CVD is especially prevalent among home care patients, a population that tends to be elderly, functionally impaired, and clinically complex. 6,7 Home care is often the first line of rehabilitation and support for elderly patients post-hospitalization, providing an opportune setting for interventions similar to those received by patients who attend outpatient cardiac rehabilitation (CR). 8,9 Home-based and center-based cardiac rehabilitation are equally effective in improving both clinical outcomes, with no differ- ence between findings in the two settings in short term exercise capacity, systolic blood pressure, total cholesterol, smoking behaviors, and cardiac events. 10 Despite these proven clinical outcomes, most home care agencies have yet to offer structured CR programs within their practice due to a lack of reimburse- ment mechanism and the logistical challenges of incorporating CR within the limitations of a home care episode. 9 Furthermore, there is limited research focusing on frail, elderly patients in CR programs. 11 The Middle-Range Theory of Self-care describes health-promoting practices required for chronic illness man- agement, with the key concepts being self-care maintenance, self-care monitoring, and self-care management. 12 This theory depicts the importance of promoting maintenance behaviors (such as preparing healthy food or coping with stress) as well as understanding the management of the chronic illness (such as understanding that shortness of breath due to heart failure may require taking an extra diuretic), which we incorporated into our intervention. 12 Based on the Middle Range Theory of Funding source: University of Pennsylvania President’s Engagement Prize * Corresponding author. Visiting Nurse Service of NY,1250 Broadway 7th Floor, New York, NY, 10001, USA. E-mail address: jodi.feinberg@homehearthealth.org (J.L. Feinberg). Contents lists available at ScienceDirect Geriatric Nursing journal homepage: www.gnjournal.com 0197-4572/$ e see front matter Ó 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2017.08.006 Geriatric Nursing xx (2017) 1e8