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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.
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