Key result
A Pulmonary Rehabilitation Stewardship program significantly increased the referral rate to pulmonary rehabilitation upon discharge for patients admitted with acute COPD exacerbation from 12.5% to 62.5%.
Why the study?
Pulmonary rehabilitation benefits COPD patients, but barriers including lack of provider knowledge limit utilization, motivating a quality improvement project to improve referral rates after hospitalization for acute exacerbation.
Does a Pulmonary Rehabilitation Stewardship program improve the referral rate to pulmonary rehabilitation in patients hospitalized for acute exacerbation of COPD?
Does a Pulmonary Rehabilitation Stewardship program improve the referral rate to pulmonary rehabilitation in patients hospitalized for acute exacerbation of COPD?
Effect estimate: 50% difference (95% CI 16.5%-71%)
Absolute Event Rate: 62.5% vs 12.5%
p-value: p=0.004
A Pulmonary Rehabilitation Stewardship program significantly increased the rate of referral to pulmonary rehabilitation for patients hospitalized with acute COPD exacerbations.
May support PR stewardship to boost referrals after COPD exacerbation; hypothesis-generating and needs prospective validation before practice change.
Background: Pulmonary rehabilitation (PR) has multiple benefits in COPD patients. There are multiple barriers to utilize PR including lack of knowledge about the benefits of PR by providers. Objective: We are conducting a Quality Improvement project to improve the referral rate of patients hospitalized for acute exacerbation of COPD to PR. Methods: All patients admitted with a primary diagnosis of acute exacerbation of COPD requiring systemic steroids to Rochester General Hospital in the period between 7/1/2019 and 7/31/2019 were reviewed retrospectively. Between 7/15/2020 and 11/15/2020, we started a PR stewardship program, where we daily review patients hospitalized with acute COPD exacerbation, and then a note will be placed in the chart for the primary team to consider referring patients to PR upon discharge, patients' charts were reviewed after discharge. The rate of referral before and after the intervention was compared. Results: During the pre-intervention period, 16 patients (mean age 67.7) with confirmed COPD by spirometry were hospitalized for COPD exacerbation, among them only 2 were referred to PR upon discharge (12.5%). During the post intervention period, 16 patients (mean age 65.0) were admitted with acute COPD exacerbation, among them 10 were referred to PR upon discharge (62.5%) [50% difference (16.5%-71%, 95% CI), P value = 0.004]. Conclusion: In our QI improvement project, we conclude that having a PR stewardship program to review patients hospitalized with COPD exacerbation significantly improves the referral rate to PR, and might help to improve utilization of those programs by patients who need them.
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Thabet et al. (2022) conducted a letter in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AE-COPD) (n=32). Pulmonary Rehabilitation Stewardship program vs. Pre-intervention (standard care) was evaluated on Referral rate to pulmonary rehabilitation upon discharge (50% difference, 95% CI 16.5%-71%, p=0.004). A Pulmonary Rehabilitation Stewardship program significantly increased the referral rate to pulmonary rehabilitation upon discharge for patients admitted with acute COPD exacerbation from 12.5% to 62.5%.
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