Increasing Pulmonary Rehabilitation Uptake after Hospitalization for Chronic Obstructive Pulmonary Disease Exacerbation. Let's Rise to the Challenge.
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ABSTRACT:
SUBMITTER: Rochester CL
PROVIDER: S-EPMC7301731 | biostudies-literature | 2020 Jun
REPOSITORIES: biostudies-literature
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Increasing Pulmonary Rehabilitation Uptake after Hospitalization for Chronic Obstructive Pulmonary Disease Exacerbation. Let's Rise to the Challenge.
Rochester Carolyn L CL Singh Sally J SJ
American journal of respiratory and critical care medicine 20200601 12
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Project description:RationaleCurrent guidelines recommend pulmonary rehabilitation (PR) after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, but little is known about its adoption or factors associated with participation.ObjectivesTo evaluate receipt of PR after a hospitalization for COPD exacerbation among Medicare beneficiaries and identify individual- and hospital-level predictors of PR receipt and adherence.MethodsWe identified individuals hospitalized for COPD during 2012 and recorded receipt, timing, and number of PR visits. We used generalized estimating equation models to identify factors associated with initiation of PR within 6 months of discharge and examined factors associated with number of PR sessions completed.ResultsOf 223,832 individuals hospitalized for COPD, 4,225 (1.9%) received PR within 6 months of their index hospitalization, and 6,111 (2.7%) did so within 12 months. Median time from discharge until first PR session was 95 days (interquartile range, 44-190 d), and median number of sessions completed was 16 (interquartile range, 6-25). The strongest factor associated with initiating PR within 6 months was prior home oxygen use (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.39-1.59). Individuals aged 75-84 years and those aged 85 years and older (respectively, OR, 0.70; 95% CI, 0.66-0.75; and OR, 0.25; 95% CI 0.22-0.28), those living over 10 miles from a PR facility (OR, 0.42; 95% CI, 0.39-0.46), and those with lower socioeconomic status (OR, 0.42; 95% CI, 0.38-0.46) were less likely to receive PR.ConclusionsTwo years after Medicare began providing coverage for PR, participation rates after hospitalization were extremely low. This highlights the need for strategies to increase participation.
| S-EPMC6344454 | biostudies-literature
Project description:RationaleClinical trials outside of the United States have assessed whether pulmonary rehabilitation (PR) decreases readmission rates for chronic obstructive pulmonary disease (COPD). We investigated if PR was associated with lower readmission risk for Medicare patients hospitalized for COPD.MethodsWe identified adults enrolled in Medicare hospitalized for COPD exacerbation from a random sample of 5 million Medicare beneficiaries (2010-2012). Patients received PR if they attended ≥1 outpatient session. A cohort was identified to study non-elective, 30-day all-cause readmissions; a subcohort was identified to study 1-year all-cause readmissions. We used stabilized inverse probability weights to balance groups by patient demographics, comorbidities, frailty, smoking status, and long-term oxygen use. We performed cause-specific regression with death as a competing risk.ResultsOf 1,839,827 hospitalizations from 2011-2012, we identified 78,074 for COPD. The 30-day cohort contained 7825 COPD index hospitalizations, of which 235 (3%) received PR; the1-year cohort contained 3401, of which 108 (3%) received PR. The median number of PR sessions was 3 (interquartile range 1-11) for both cohorts. The hazard ratio for 30-day readmission was 0.47 (95% confidence interval [CI] 0.33-0.68, P<0.0001). The hazard ratio for 1-year readmission was 1.45 (95% CI 1.19-1.76, P<0.001).ConclusionsThis is one of the first studies of PR and readmissions in Medicare patients. We found that PR was associated with a lower risk of 30-day all-cause readmissions but a higher risk of 1-year all-cause readmission.
| S-EPMC8686849 | biostudies-literature
Project description:Investigation of whole genome gene expression level changes of the dynamic gene profiling of peripheral blood mononuclear cells (PBMCs) from patients with AECOPD) on day1, 3 and 10, compared to the normal people and stable COPD patients. A five chip study using total RNA recovered from Peripheral Blood Mononuclear Cell of Peripheral Blood.Evaluating the dynamic gene profiling of peripheral blood mononuclear cells (PBMCs) from patients with AECOPD) on day1, 3 and 10 after the hospital admission, to compared with healthy controls or patients with stable COPD. Slides were scanned at 5 μm/pixel resolution using an Axon GenePix 4000B scanner (Molecular Devices Corporation) piloted by GenePix Pro 6.0 software (Axon). Scanned images (TIFF format) were then imported into NimbleScan software (version 2.5) for grid alignment and expression data analysis. Expression data were normalized through quantile normalization and the Robust Multichip Average (RMA) algorithm included in the NimbleScan software. The Probe level (*_norm_RMA.pair) files and Gene level (*_RMA.calls) files were generated after normalization.
2014-08-14 | E-GEOD-60399 | biostudies-arrayexpress
Project description:This study aimed to investigate (a) the association between psychological flexibility and engagement in pulmonary rehabilitation within 8 weeks following hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and (b) how psychological (in)flexibility presents in this context. A mixed-methods study was conducted. Psychological flexibility during an AECOPD was assessed using The Acceptance and Action Questionnaire-II (AAQ-II) (n = 41) and the Engaged Living Scale (ELS) (n = 40). Engagement in post-AECOPD pulmonary rehabilitation was then recorded. Twenty-three patients also participated in cognitive interviews. Psychological flexibility was associated with a greater chance of accepting a pulmonary rehabilitation referral following an AECOPD. Small numbers prohibited analysis on attendance or completion. An AAQ-II score of 11 translated to a 60 (37-82)% probability of accepting a referral to pulmonary rehabilitation and an ELS score of 73 was associated with a 68 (46-91)% probability of accepting. Four themes were extracted from interviews: (1) family values, (2) self as abnormal, (3) 'can't do anything' versus 'I do what I can' and (4) disability, and related emotions, as barriers to action. Randomised clinical trials are needed to evaluate interventions designed to increase psychological flexibility (i.e. acceptance and commitment therapy) to support acceptance of pulmonary rehabilitation post-AECOPD.
| S-EPMC6769226 | biostudies-literature
Project description:Investigation of whole genome gene expression level changes of the dynamic gene profiling of peripheral blood mononuclear cells (PBMCs) from patients with AECOPD) on day1, 3 and 10, compared to the normal people and stable COPD patients.
2014-08-14 | GSE60399 | GEO
Project description:BackgroundTelehealth interventions for patients with chronic obstructive pulmonary disease (COPD) have focused primarily on stable outpatients. Telehealth designed to handle the acute exacerbation that normally requires hospitalization could also be of interest. The aim of this study was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD.Materials and methodsA two-center, noninferiority, randomized, controlled effectiveness trial was conducted between June 2010 and December 2011. Patients with severe COPD admitted because of exacerbation were randomized 1:1 either to home-based telehealth hospitalization or to continue standard treatment and care at the hospital. The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge. The noninferiority margin was set at 20% of the control group's risk of re-admission. Secondary outcomes were mortality, need for manual or mechanical ventilation or noninvasive ventilation, length of hospitalization, physiological parameters, health-related quality of life, user satisfaction, healthcare costs, and adverse events.ResultsIn total, 57 patients were randomized: 29 participants in the telehealth group and 28 participants in the control group. Testing the incidence of re-admission within 30 days after discharge could not confirm noninferiority (lower 95% confidence limit [CL], -24.8%; p=0.35). Results were also nonsignificant at 90 days (lower 95% CL, -16.2%; p=0.33) and 180 days (lower 95% CL, -16.6%; p =0.33) after discharge. Superiority testing on secondary outcomes showed nonsignificant differences between groups. Healthcare costs have not yet been evaluated.ConclusionsWhether home-based telehealth hospitalization is noninferior to conventional hospitalization requires further investigation. The results indicate that a subgroup of patients with severe COPD can be treated for acute exacerbation at home using telehealth, without the physical presence of health professionals and with a proper organizational "back-up."
| S-EPMC4432494 | biostudies-literature
Project description: Not available
| S-EPMC10008021 | biostudies-literature
Project description:Pulmonary strongyloidiasis is an uncommon presentation of Strongyloides infection, usually seen in immunocompromised hosts. The manifestations are similar to that of acute exacerbation of chronic obstructive pulmonary disease (COPD). Therefore, the diagnosis of pulmonary strongyloidiasis could be challenging in a COPD patient, unless a high index of suspicion is maintained. Here, we present a case of Strongyloides hyperinfection in a COPD patient mimicking acute exacerbation, who was on chronic steroid therapy.
| S-EPMC5077736 | biostudies-literature
Project description:Exacerbations are important disease events for patients with chronic obstructive pulmonary disease (COPD) as they are relatively frequent, result in significant resource use and can indicate worsening disease. Little is known about variation in COPD exacerbation rates across a health system in various geographic regions.To compare COPD exacerbation rates by regional service networks called Veterans Integrated Service Network (VISN) in the Veterans Health Administration (VA) system.Retrospective, observational study.Patients with a COPD diagnosis from October 1999 to September 2000 with follow-up to September 2002.Acute exacerbations of COPD during the baseline and follow-up periods.A total of 198,981 patients were identified. Average exacerbation rate at baseline was 0.503 events per person per year. In the follow-up period, there were 187,686 exacerbations experienced by 87,494 persons (44.0% of cohort). During follow-up, the average adjusted exacerbation rate was 0.589 per person per year and varied from 0.335 (95% CI, 0.328-0.342) in VISN 1 to 0.749 (95% CI, 0.735-0.0.763) in VISN 9. Using the median rate of exacerbation during the baseline period as the referent, 9 VISNs had lower adjusted rate ratios and 12 VISNs had higher adjusted rate ratios in the follow-up period.Geographic variation in the VA VISN system supports evidence that the medical care system including provider factors, and less so patient factors, affect COPD exacerbations. Understanding the reasons underlying this variation in COPD exacerbation rates may lead to improvements in future care and outcomes.
| S-EPMC2219808 | biostudies-other
Project description:BackgroundPeople with symptomatic chronic obstructive pulmonary disease (COPD) benefit from pulmonary rehabilitation programs (PRPs), but program attrition is common.MethodsFor people with COPD who presented to tertiary care and appeared appropriate for a PRP, we prospectively mapped their PRP journey, explored factors influencing attendance to pre-program assessment and captured program attrition.ResultsOf the 391 participants, 31% (95% CI 27 to 36) were referred to a PRP (n = 123; age 68 ± 10years, 62 males [50%], FEV1 45 ± 19%predicted). Of those referred, 94 (76% [69 to 84]) attended a pre-program assessment. Ex-smokers and those who had a healthcare professional (HCP) explain they would be referred were more likely to attend a pre-program assessment (odds ratio [95%CI]; 2.6 [1.1 to 6.1]; and 4.7 [1.9 to 11.7], respectively). Of the 94 who attended, 63 (67% [58 to 77]) commenced; and of those who commenced, 35 (56% [43 to 68]) completed a PRP. All who completed (n = 35, 100%) were provided at least one strategy to maintain training-related gains.ConclusionAttrition occurs throughout the PRP journey. Interactions with HCPs about PRPs positively influenced attendance. Understanding how HCPs can best contextualise PRPs to encourage referral acceptance and uptake is an important area for further work.
| S-EPMC10771047 | biostudies-literature