Association Between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with COPD.

RATIONALE: Althoughl clinical trials have found that pulmonary rehabilitation (PR) can reduce the risk of readmissions following hospitalization for a COPD exacerbation, less is known about PR's impact in routine clinical practice.

OBJECTIVE: We evaluated 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) hospitalized for COPD in 2014 who survived at least 30 days following discharge.

MEASUREMENTS: We used propensity score (PS) matching and estimated the risk of recurrent all-cause rehospitalizations at one year using a multi-state model to account for the competing risk of death.

MAIN RESULTS: Of 197,376 patients hospitalized in 4,446 hospitals, 2,721 patients (1.5%) initiated PR within 90 days of discharge. Overall, 1,534 (56.4%) of patients who initiated PR and 125,720 (64.6%) who did not were rehospitalized one or more times within one year of discharge. In the PS matched analysis, PR initiation was associated with a lower risk of readmission in the year following PR initiation (Hazard Ratio: 0.83; 95% CI: 0.77 - 0.90). The mean cumulative number of rehospitalizations at one 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 one year. These results support findings from randomized clinical trials and highlight the need to identify effective strategies to increase PR participation. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/).