A mixed methods study to analyze the use of pulmonary rehabilitation following hospitalization for COPD, and to identify effective strategies for increasing rates of participation - PROJECT SUMMARY / ABSTRACT
Chronic obstructive pulmonary disease (COPD) affects 15 to 24 million individuals in the US, is the nation's
third leading cause of death, and exacerbations result in some 700,000 annual hospital admissions. Patients
who require hospitalization suffer profound reductions in functional status and health-related quality of life that
can take months to recover from. Pulmonary rehabilitation (PR) is a structured set of interventions that includes
exercise training, education, behavior change and support, designed to improve the physical and psychological
well-being of patients with chronic respiratory disease. Evidence demonstrating the benefits of PR for patients
with stable COPD has been accruing for decades. However, in more recent years, randomized trials have
shown that initiating PR during or soon after an exacerbation increases functional status, prevents
rehospitalization, and improves survival. Starting PR after an exacerbation is now strongly recommended in
clinical guidelines. Recognizing its many benefits, Medicare began providing insurance coverage for PR
services in 2010 to patients with moderate-to-severe COPD. While the clinical impact of this landmark policy
decision remains largely unknown, our preliminary data suggest that only a small fraction of potentially eligible
individuals are receiving treatment. Additionally, these data suggest that rates of participation vary widely
across hospitals, as do the strategies used to promote patient participation.
Our long-term goal is to improve the quality of life of patients with COPD by optimizing participation in PR.
The objective of this proposal is to analyze the translation of PR into routine clinical practice among Medicare
beneficiaries following hospitalization for COPD, and to identify the factors and strategies that enable some
hospitals to achieve higher rates of participation than others. The proposed research will be carried out in 2
phases. The first phase (Aim 1) consists of a series of longitudinal and cross-sectional multivariable analyses
using linked Medicare files. This research will close major gaps in our understanding of the uptake of PR
following hospitalization, will provide novel insights about potential disparities in care, will describe and analyze
sources of geographic variation, and will identify a group of hospitals with very high and very low rates of
participation in PR. The second phase (Aims 2 and 3) involves the application of mixed qualitative and survey
methods to refine, generate, and subsequently test hypotheses about the contextual factors and strategies that
enable some hospitals to be more successful at getting patients to participate in PR than others. These
activities are highly responsive to the NHLBI Strategic Plan goal to “Advance Translational Research”,
specifically, “To facilitate innovation and accelerate research translation, knowledge dissemination, and
implementation science that enhances public health.”
