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Observational Study
. 2021 Nov 1;204(9):1015-1023.
doi: 10.1164/rccm.202012-4389OC.

Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease

Mihaela S Stefan  1   2 , Penelope S Pekow  1   3 , Aruna Priya  1   3 , Richard ZuWallack  4 , Kerry A Spitzer  1 , Tara C Lagu  5   6 , Quinn R Pack  1   2   7 , Victor M Pinto-Plata  2   8 , Kathleen M Mazor  9 , Peter K Lindenauer  1   2   10
Affiliations
Observational Study

Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease

Mihaela S Stefan et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Although clinical trials have found that pulmonary rehabilitation (PR) can reduce the risk of readmissions after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, less is known about PR's impact in routine clinical practice. Objectives: To evaluate the association between initiation of PR within 90 days of discharge and rehospitalization(s). Methods: We analyzed a retrospective cohort of Medicare beneficiaries (66 years of age or older) hospitalized for COPD in 2014 who survived at least 30 days after discharge. Measurements and Main Results: We used propensity score matching and estimated the risk of recurrent all-cause rehospitalizations at 1 year using a multistate model to account for the competing risk of death. Of 197,376 total patients hospitalized in 4,446 hospitals, 2,721 patients (1.5%) initiated PR within 90 days of discharge. Overall, 1,534 (56.4%) patients who initiated PR and 125,720 (64.6%) who did not were rehospitalized one or more times within 1 year of discharge. In the propensity-score-matched analysis, PR initiation was associated with a lower risk of readmission in the year after PR initiation (hazard ratio, 0.83; 95% confidence interval, 0.77-0.90). The mean cumulative number of rehospitalizations at 1 year was 0.95 for those who initiated PR within 90 days and 1.15 for those who did not (P < 0.001). Conclusions: After hospitalization for COPD, Medicare beneficiaries who initiated PR within 90 days of discharge experienced fewer rehospitalizations over 1 year. These results support findings from randomized controlled clinical trials and highlight the need to identify effective strategies to increase PR participation.

Keywords: chronic lung disease; physical exercise; readmissions.

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Figures

Figure 1.
Figure 1.
Multistate models for (A) all-cause rehospitalization and (B) chronic obstructive pulmonary disease (COPD) and non-COPD rehospitalizations. Hosp = hospitalization.
Figure 2.
Figure 2.
Absolute standardized differences for patient characteristics in the full cohort and propensity analysis. ARF = acute respiratory failure; COPD = chronic obstructive pulmonary disease; IMV = invasive mechanical ventilation; NIV = noninvasive ventilation; OSA = obstructive sleep apnea; PN = pneumonia; PR = pulmonary rehabilitation; PS = propensity score; SNF = skilled nursing facility.
Figure 3.
Figure 3.
Multistate analysis using Cox proportional regression in the propensity-matched analysis. PR = pulmonary rehabilitation.
See this image and copyright information in PMC

Comment in

References

    1. Guarascio AJ, Ray SM, Finch CK, Self TH. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res . 2013;5:235–245. - PMC - PubMed
    1. Lindenauer PK, Dharmarajan K, Qin L, Lin Z, Gershon AS, Krumholz HM. Risk trajectories of readmission and death in the first year following hospitalization for COPD. Am J Respir Crit Care Med . 2018;197:1009–1017. - PMC - PubMed
    1. Goto T, Faridi MK, Gibo K, Toh S, Hanania NA, Camargo CA, Jr, et al. Trends in 30-day readmission rates after COPD hospitalization, 2006-2012. Respir Med . 2017;130:92–97. - PMC - PubMed
    1. Bahadori K, FitzGerald JM. Risk factors of hospitalization and readmission of patients with COPD exacerbation--systematic review. Int J Chron Obstruct Pulmon Dis . 2007;2:241–251. - PMC - PubMed
    1. Müllerova H, Maselli DJ, Locantore N, Vestbo J, Hurst JR, Wedzicha JA, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest . 2015;147:999–1007. - PubMed

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