CHIBE Team Member


University of Pennsylvania Health System

Using Default Options to Increase Referral to Cardiac Rehabilitation


Cardiac rehabilitation has been demonstrated to reduce mortality by up to 30% in high-risk cardiovascular patients. However, less than 33% of eligible patients actually participated in a formal program. Health system’s often struggle to effective refer eligible patients and this contributes to the low participation rates. At Penn Medicine, we founds that cardiologists had to manually identify these patients during their busy inpatient rounds and opt-in to refer them to cardiac rehabilitation.

Our Approach

We worked with the Penn Medicine Heart and Vascular service line to redesign the referral process by changing defaults from opt-in to opt-out. This included automating the identification of eligible patients, delivering real-time notifications to frontline providers and restructuring both rounds and the discharge process. Eligible are by default to be referred to a cardiac rehabilitation program unless the cardiologist opts out.


This intervention was implemented at the Hospital of the University of Pennsylvania in 2017 and is currently being evaluated