The Effect of Pulmonary Rehabilitation on Healthcare Utilization in Chronic Obstructive Pulmonary Disease

Abstract

Although pulmonary rehabilitation results in improvement in multiple outcome areas, relatively few studies in the United States have evaluated its effect on healthcare utilization. This study compared aspects of healthcare utilization during the year before to the year after outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease referred to 11 hospital-based centers in Connecticut and New York. Utilization data from 128 of 132 patients who originally gave informed consent were evaluated; their mean age was 69 years and their forced expiratory volume in 1 second was 44% of predicted. Forty-five percent had 1 or more hospitalizations in the year before beginning pulmonary rehabilitation. In the year after pulmonary rehabilitation, there were 0.25 fewer total hospitalizations (P = .017) and 2.18 fewer hospital days (P = .015) per patient and 271 fewer hospital days for the group. Hospitalizations for respiratory reasons also decreased significantly. Most of the reduction in hospital utilization was due to a decrease in intensive care unit days. The number of physician visits decreased by 2.4 in the year after pulmonary rehabilitation (P < .0001); most of this reduction was due to decreased visits to primary care providers. The estimated costs/charges for the aspects of healthcare utilization that we studied decreased by a mean of 4,694 dollars and a median of 390 dollars (P = .0002). This study suggests that pulmonary rehabilitation leads to a reduction in healthcare utilization.

Pulmonary Rehabilitation in Emphysema

“…Overall, the results from pulmonary rehabilitation in NETT confirm and extend those previously published from single, specialized pulmonary rehabilitation centers as well as other multicenter outcome studies (23)(24)(25), and provide strong evidence that the benefits from pulmonary rehabilitation as currently practiced are generalizable to community-based centers.…”

Pulmonary Rehabilitation: A Retrospective Study in Eastern North Carolina

“…This outcome would likely result in a reduction in health care costs, which is consistent with the findings of other studies [18][19][20]. In one such study by Raskin and colleagues, 128 patients received PR at 11 outpatient centers, and there were 0.25 fewer hospitalizations in the year following PR [21]. In another study, the California Pulmonary Rehabilitation Collaborative Group analyzed a total of 522 patients in 9 centers and demonstrated a significant decline in health care resource utilization 18 months after PR [22].…”

Outpatient-Based Pulmonary Rehabilitation for COPD: A Cost of Illness Study

“…Similar results were reported from a large study in USA, where most of the reduction in hospital utilization was due to a decrease in intensive care unit days and the number of physician visits (decreased by 2.4) in the year after PR. The estimated costs/charges for the aspects of healthcare utilization that were studied decreased by a mean of 4.694 US dollars and a median of 390 US dollars [25].…”