Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease among Medicare Beneficiaries

Abstract

Rationale: Current guidelines recommend pulmonary rehabilitation (PR) after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, but little is known about its adoption or factors associated with participation. Objectives: To evaluate receipt of PR after a hospitalization for COPD exacerbation among Medicare beneficiaries and identify individual-and hospital-level predictors of PR receipt and adherence. Methods: We identified individuals hospitalized for COPD during 2012 and recorded receipt, timing, and number of PR visits. We used generalized estimating equation models to identify factors associated with initiation of PR within 6 months of discharge and examined factors associated with number of PR sessions completed. Results: Of 223,832 individuals hospitalized for COPD, 4,225 (1.9%) received PR within 6 months of their index hospitalization, and 6,111 (2.7%) did so within 12 months. Median time from discharge until first PR session was 95 days (interquartile range, 44-190 d), and median number of sessions completed was 16 (interquartile range, 6-25). The strongest factor associated with initiating PR within 6 months was prior home oxygen use (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.39-1.59). Individuals aged 75-84 years and those aged 85 years and older (respectively, OR, 0.70; 95% CI, 0.66-0.75; and OR, 0.25; 95% CI 0.22-0.28), those living over 10 miles from a PR facility (OR, 0.42; 95% CI, 0.39-0.46), and those with lower socioeconomic status (OR, 0.42; 95% CI, 0.38-0.46) were less likely to receive PR. Conclusions: Two years after Medicare began providing coverage for PR, participation rates after hospitalization were extremely low. This highlights the need for strategies to increase participation.

Design for a multicenter, randomized, sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira® lung denervation system in subjects with chronic obstructive pulmonary disease (AIRFLOW-3)

“…This is typically achieved in 4 activations. The catheter is then retracted, and the opposite main bronchus treated under-utilized in COPD, particularly in the US [25]. Therefore, a requirement for PR program completion, while ideal, would result in a potential impediment to enrollment for significant numbers of otherwise qualified subjects.…”

Physical exercise during acute exacerbations of chronic obstructive pulmonary disease: Australian physiotherapy practice

“…We know, however, that actual international referral and uptake rates after AECOPD are very poor (less than 10%). [13][14][15] To the best of our knowledge, our data suggesting an increased self-perceived rate of referrals by physiotherapists with greater experience (>5 years) working in the cardiorespiratory field (Figure 3) is the first of its kind. While one could speculate those with less experience have less responsibilities to initiate PR referrals or may lack familiarity with referral procedures, it is important to note this group reflects the majority (65%) of the workforce represented in this survey.…”

“…9 International guidelines recommend PR to commence within 2-4 weeks of discharge, [10][11][12] however rates of referral, uptake and completion of PR following AECOPD are suboptimal. [13][14][15] Despite important progress regarding the impact of rehabilitation interventions applied during the period of hospitalisation for AECOPD, [16][17][18][19] data are scant regarding how physiotherapists approach this aspect of clinical practice. This is important to ascertain, as physiotherapists play a key role in the management of patients hospitalised with AECOPD, including referrals to PR after discharge.…”

Profiling of Patients with COPD for Adequate Referral to Exercise-Based Care: The Dutch Model

“…Such programs have shown to also improve the performance of activities of daily living, to increase self-efficacy, and to lower the degree of care dependency and healthcare utilization [5,[10][11][12][13][14] in COPD patients with a combination of physical, emotional and/or social treatable traits. Even though safety and efficacy of these interventions are clear, referral by physicians remains poor [15].…”