Kerry A Spitzer1, Mihaela S Stefan1,2, Aruna Priya1,3, Quinn R Pack1,2,4, Penelope S Pekow1,3, Tara Lagu1,2, Victor M Pinto-Plata5, Richard L ZuWallack6, Peter K Lindenauer1,2,7. 1. 1 Institute for Healthcare Delivery and Population Science and. 2. 2 Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts. 3. 3 School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts. 4. 4 Division of Cardiovascular Medicine, and. 5. 5 Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, Massachusetts. 6. 6 Saint Francis Hospital and Medical Center, Hartford, Connecticut; and. 7. 7 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
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.
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.
Authors: Elizabeth Moore; Roger Newson; Miland Joshi; Thomas Palmer; Kieran J Rothnie; Sally Singh; Azeem Majeed; Michael Soljak; Jennifer K Quint Journal: Chest Date: 2017-05-16 Impact factor: 9.410
Authors: Gerard J Criner; Jean Bourbeau; Rebecca L Diekemper; Daniel R Ouellette; Donna Goodridge; Paul Hernandez; Kristen Curren; Meyer S Balter; Mohit Bhutani; Pat G Camp; Bartolome R Celli; Gail Dechman; Mark T Dransfield; Stanley B Fiel; Marilyn G Foreman; Nicola A Hanania; Belinda K Ireland; Nathaniel Marchetti; Darcy D Marciniuk; Richard A Mularski; Joseph Ornelas; Jeremy D Road; Michael K Stickland Journal: Chest Date: 2015-04 Impact factor: 9.410
Authors: Surya P Bhatt; Siddharth B Patel; Erica M Anderson; Daniel Baugh; Tina Givens; Christopher Schumann; J Gregory Sanders; Samuel T Windham; Gary R Cutter; Mark T Dransfield Journal: Am J Respir Crit Care Med Date: 2019-08-15 Impact factor: 21.405
Authors: Laura J Spece; Lucas M Donovan; Matthew F Griffith; Thomas Keller; Laura C Feemster; Nicholas L Smith; David H Au Journal: Ann Am Thorac Soc Date: 2020-05
Authors: Valentin Prieto-Centurion; Richard Casaburi; David B Coultas; Mayank M Kansal; Spyros Kitsiou; Julia J Luo; Jun Ma; Cynthia S Rand; Ai-Yui M Tan; Jerry A Krishnan Journal: Chronic Obstr Pulm Dis Date: 2019-10-23
Authors: Kerry A Spitzer; Mihaela S Stefan; Aruna Priya; Quinn R Pack; Penelope S Pekow; Tara Lagu; Kathy M Mazor; Victor M Pinto-Plata; Richard L ZuWallack; Peter K Lindenauer Journal: Chest Date: 2020-01-17 Impact factor: 9.410
Authors: Surya P Bhatt; Daniel Baugh; Jason Hitchcock; Young-Il Kim; Gary Cutter; Inmaculada Aban; Mark T Dransfield Journal: Ann Am Thorac Soc Date: 2022-02
Authors: Narelle S Cox; Simone Dal Corso; Henrik Hansen; Christine F McDonald; Catherine J Hill; Paolo Zanaboni; Jennifer A Alison; Paul O'Halloran; Heather Macdonald; Anne E Holland Journal: Cochrane Database Syst Rev Date: 2021-01-29
Authors: Matthew F Griffith; Hung-Yuan P Chen; David B Bekelman; Laura C Feemster; Laura J Spece; Lucas M Donovan; David H Au; Evan P Carey Journal: Ann Am Thorac Soc Date: 2021-03