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J Cardiopulm Rehabil Prev. 2015 Sep-Oct;35(5):356-66. doi: 10.1097/HCR.0000000000000128.

Impact of pulmonary rehabilitation on hospitalizations for chronic obstructive pulmonary disease among members of an integrated health care system.

Author information

1
Department of Research and Evaluation (Drs Nguyen and Gould and Mss Liu and Lee), and Pulmonary and Critical Care, Kaiser Permanente Southern California (Dr Harrington), Pasadena.

Abstract

PURPOSE:

The evidence regarding the effects of pulmonary rehabilitation (PR) on health care resource use remains limited. This retrospective study evaluated the effects of PR on the primary outcome of all-cause hospitalizations and secondary outcomes of other health care use, exercise capacity, health-related quality of life (HRQOL), and body weight in patients with chronic obstructive pulmonary disease (COPD) in a large integrated health care system.

METHODS:

The PR cohort included 558 patients with a COPD diagnosis, age ≥ 40 years, who were treated with a bronchodilator or steroid inhaler, participated in 1 of 13 PR programs between January 1, 2008, and August 1, 2013, and were continuously enrolled in the health plan ≥ 12 months prior to and after PR. Two non-PR control cohorts were assembled for comparison. Data were extracted from electronic health records. The 6-minute walk test and St. George's Respiratory Questionnaire results were available for a subset.

RESULTS:

The proportion of patients who were hospitalized 12 months post-PR was lower compared with the 12 months prior (37% vs 45%, P = .001) while emergency department use was not different (52% vs 54%). Patients who declined PR for logistical reasons had a 40% higher risk of hospitalization than PR participants (relative risk = 1.40, 95% CI: 0.96-2.06, P = .08). There were significant improvements in the 6-minute walk test distance (+43 m) and the St. George's Respiratory Questionnaire total score (-9.6 points) but minimal changes in weight.

CONCLUSIONS:

Our finding that participation in PR is associated with reductions in hospitalizations corroborates previous studies. A notable strength of this study is the capture of complete utilization data.

PMID:
26181038
DOI:
10.1097/HCR.0000000000000128
[Indexed for MEDLINE]

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