Pulmonary rehabilitation and readmission rates for medicare beneficiaries with acute exacerbation of chronic obstructive pulmonary disease

Abstract

Rationale: Clinical 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. Methods: We 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. Results: Of 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). Conclusions: This 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.