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

• Published in: American journal of respiratory and critical care medicine Vol. 204; no. 9; pp. 1015 - 1023
• Main Authors: Stefan, Mihaela S, Pekow, Penelope S, Priya, Aruna, ZuWallack, Richard, Spitzer, Kerry A, Lagu, Tara C, Pack, Quinn R, Pinto-Plata, Victor M, Mazor, Kathleen M, Lindenauer, Peter K
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01-11-2021
• Subjects: Aged; Aged, 80 and over; Chronic obstructive pulmonary disease; Clinical trials; Cohort Studies; Female; Hospitalization - statistics & numerical data; Humans; Male; Medicare; Older people; Original; Patient Readmission - statistics & numerical data; Proportional Hazards Models; Pulmonary Disease, Chronic Obstructive - rehabilitation; Retrospective Studies; Risk Assessment - statistics & numerical data; Risk factors; Studies; Time Factors; United States; United States; physical exercise; chronic lung disease; readmissions
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.202012-4389OC

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.
To evaluate the association between initiation of PR within 90 days of discharge and rehospitalization(s).
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.
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 (
 < 0.001).
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.