How did the Stanford Cardiac Rehabilitation Program conceive of the idea of SCCMS in the first place?
The idea evolved over nearly 30 years, during which the Stanford team demonstrated the efficacy of successive generations of physician-directed, nurse-managed telephone-mediated care management approaches for the management of chronic cardiovascular conditions. It was the failure of the last of these studies, conducted in Kaiser Permanente Hospitals 1999-2001 and focused on reducing readmissions for heart failure, that the investigators had an epiphany: to change treatment practice, it is necessary to establish telephone contact with patients at the very outset of symptoms of concern to them, not after they have seen their physicians in clinic or undergone ER evaluation. The “default” decision in these clinical settings is to refer patients from clinic to the ER and from the ER to the hospital. However, if patients call immediately after the onset of symptoms, it is usually possible to resolve their problems without the need for ER visits or hospitalizations. The Stanford team would no
