Use of Pulmonary Rehabilitation After COPD Hospitalization: An Analysis of Statewide Patient and Hospital Data.

RATIONALE: Pulmonary rehabilitation (PR) is a clinically and cost-effective outpatient treatment for COPD that remains highly underutilized. Existing analyses of PR utilization patterns have been largely focused on patient characteristics, however hospital level analysis is lacking, and is needed to inform interventions aimed at improving utilization after COPD hospitalization.

OBJECTIVE: To evaluate PR utilization across hospitals after COPD hospitalization in the state of Michigan, with the goal of characterizing hospital level variation and identifying the characteristics of high-performing hospitals.

METHODS: This is a retrospective study of patients with a COPD hospitalization between 1/1/18 and 12/31/21 using claims data from the Michigan Value Collaborative (MVC) and hospital data from the American Hospital Association annual survey. Our primary outcome was initiation of PR within 30 days of discharge. Chi-square tests and ANOVA were used to test for differences in patient and hospital covariates. Multilevel logistic regression was used to analyze associations between patient covariates and the primary outcome, and to characterize hospital level variation.

RESULTS: A total of 36,389 patients and 99 hospitals were included in the analysis. The majority of patients were older than 65 years of age, female, White, and Medicare fee-for-service insured. The rate of PR initiation within 30 days after hospitalization was 0.8%. Adjusted rates of PR initiation by hospital ranged from 0.4-2.0%. Compared to the set reference groups, being female, in the 5th Distressed Community Index quintile, and being older than 85 years of age independently decreased the odds of initiating PR. Some variation in initiation rate was attributed to the hospital level (7% ICC 0.07, 95% CI 0.03-0.15). The median odds ratio was 1.6 for PR initiation by hospital.

CONCLUSIONS: Rates of PR initiation after COPD hospitalization are universally low across all hospitals, though there is some variation. Interventions targeted at patients alone are not sufficient to improve utilization. Hospital-based strategies to improve PR utilization after discharge, adapted from those being successfully used with cardiac rehabilitation, should be further explored.