An educational intervention for internal medicine residents increased the rate of pulmonary rehabilitation referrals for patients with chronic lung disease from 0.78% to 2% over a 6-month period.
Does an educational session improve internal medicine residents' knowledge and rates of referral for pulmonary rehabilitation in patients with chronic lung disease?
An educational intervention for internal medicine residents successfully improved awareness and modestly increased referral rates for pulmonary rehabilitation in patients with chronic lung disease.
Absolute Event Rate: 2% vs 0.78%
Abstract Rationale Pulmonary rehabilitation (PR) is a comprehensive intervention designed to improve physical and psychological conditions of patients with respiratory disease and remains a strong moderate recommendation for patients with chronic lung disease (CLD) (1). It has been shown to improve exercise capacity, enhance quality of life, reduce dyspnea severity, and reduce hospital admissions due to respiratory exacerbations (2). PR is widely underutilized worldwide, with less than 5% of eligible patients participating (1). We sought to bridge the gap in resident knowledge regarding PR and its accessibility for our patients. Methods We administered a survey to internal medicine residents within our institution to gauge baseline knowledge regarding benefits of PR, identification of eligible patients, accessibility within our health system, and confidence referring for such. An educational session was given, followed by administration of a repeat survey. Data regarding the number of patients with diagnoses of CLD seen in our practice, transitional care management (TCM) appointments post-hospitalization, and number of PR referrals were extracted from our EMR pre- and post-intervention. Results Of the 33 residents who participated, 85% had never referred a patient to PR. Data revealed our intervention increased confidence in identifying patients eligible for PR (15% pre- vs 77% post-test) and comfort referring patients to PR (18% pre- vs 73% post-test). There were also improvements in correctly identifying interventions offered through PR, contraindications, benefits, and accessibility. Post-intervention data revealed that the rate of PR referral in patients with reported CLD increased from 0.78% to 2% over a 6-month period. Rates of PR referral during TCM visits increased from 5.7% to 27.3%. Discussion Poor clinician awareness of PR remains a barrier to referral, thus contributing to underutilization. This quality improvement initiative successfully improved resident awareness of PR and its benefits, increasing measures of resident confidence referring patients to PR. The first iteration yielded a modest improvement in rates of eligible patients referred to PR with a more dramatic increase in referral rates at TCM visits. Our project highlights the importance of increasing physician knowledge and confidence in referring patients for PR, which aligns with current literature emphasizing its underutilization despite evidence of its benefits (2). Limitations of this project include low power, which may be attributed to the nature of our largely underinsured patient population. Future considerations include displaying reminders in the practice and expansion to the inpatient setting to improve referral rates to PR at discharge for patients with CLD. This abstract is funded by: None
Stern et al. (Fri,) conducted a other in Chronic lung disease (n=33). Educational session on pulmonary rehabilitation vs. Pre-intervention baseline was evaluated on Rate of pulmonary rehabilitation referral in patients with reported chronic lung disease. An educational intervention for internal medicine residents increased the rate of pulmonary rehabilitation referrals for patients with chronic lung disease from 0.78% to 2% over a 6-month period.