SUBOPTIMAL UPTAKE OF OUTPATIENT PULMONARY REHABILITATION FOLLOWING DISCHARGE FOR A COPD EXACERBATION: ONE HOSPITAL'S EXPERIENCE

ABSTRACT

SESSION TITLE Practice Management Beyond Coding and Staffing SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/17/2022 1215 pm - 115 pm PURPOSE: Despite reduced health care utilization and mortality for COPD patients participating in pulmonary rehabilitation (PR) after hospitalization, few enroll in this intervention. Reasons were explored in a post-discharge survey to inform new ways to market or restructure PR. METHODS: IRB-approved, telephone survey and record review of patients with COPD discharged from one hospital over 1-year period. Inclusion criteria for analysis: 1) Principal diagnosis of COPD or respiratory failure;2) Discharge home;3) PR indicated or not contraindicated. Inclusion criteria for survey 1) Telephone consent;2) Fluency in English. RESULTS: 191 were studied. Of these, 51 (27%) were not in a home setting (26 died, 25 not discharged home), 32 (16%) had no indication for PR (11 had an incorrect diagnosis, 21 not medically indicated). Of the remaining, 62 could not be surveyed (38 not reachable, 8 language barrier, 16 refused consent), leaving 46 (24% of total group) surveyed at 132 ± 89 days following discharge. Of those surveyed, 89% had a primary care provider, 72% had a pulmonologist, 43% had heard of PR, but only 24% ever participated in this intervention. 28% were ever referred to PR. Pulmonologists were the most common referrers. Desirable outcomes and factors that might influence the patient’s decision to participate in PR are in the Table. Table. Survey Results, n = 46 Mean rankings of Importance to Patients 1 = least important, 5= most important Potential Outcomes of Importance to Patient Reduced Hospitalization Risk 4.80 Improvement in Dyspnea 4.54 Learn More About Lung Disease 4.34 Increase in Ability to do Things 4.26 Fewer Flare-ups of Lung Disease 4.26 Decrease in Tiredness or Fatigue 4.09 Reduced anxiety or nervousness 3.94 Opportunity to Interact with Others 3.49 Factors that Might Positively Influence Decision for PR Likelihood of Beneficial Outcome 4.34 Low Cost 4.23 Short Travel Distance to PR 4.00 Less Concern over Excessive Dyspnea during Exercise 3.54 Convenient Transportation to PR 3.37 Fewer Weather-Related Issues 2.89 Not Having to Get Up in the AM to Go to PR 2.66 No Family Responsibility Conflicts in Attending PR 1.97 Not Too Soon After Hospitalization 1.60 No Employment Conflicts in Attending PR 1.37 CONCLUSIONS: Despite reasonably good access to medical care, uptake of PR was poor. Important factors in under-utilization include non-indication or contraindication or non-referral to PR. CLINICAL IMPLICATIONS A major limitation of this survey is that it was conducted during the COVID-19 pandemic when PR facilities were closed. Those never participating in PR nevertheless listed desirability of outcomes typically attributed to PR. Although repeating the survey post-pandemic may yield more accurate results, current data indicates the need for improved patient education and referral to PR. This is a potential target for future interventions to increase PR usage. DISCLOSURES No relevant relationships by Osama Elsankary No relevant relationships by Antarpreet Kaur No relevant relationships by Hnin Hnin Oo No relevant relationships by Jane Reardon No relevant relationships by Ryan Talbert No relevant relationships by Richard ZuWallack