Pulmonary Rehabilitation

1. Pulmonary Rehabilitation Evaluation of the Benefits of Phase III (Maintenance) Pulmonary Rehabilitation on Participants Healthcare Quality of Life and Healthcare Utilization Charley P. Starnes, BSRT, RRT, RCP

2. Purpose • To determine if continued exercise (enrollment in a pulmonary rehabilitation maintenance program) after graduation from a medically-supervised program decreases healthcare utilization, i.e. ER visits/hospitalizations, and maintains/increases participant’s perceived quality of life and dyspnea management

3. Pulmonary Rehabilitation Phase II • Medically-supervised, outpatient program comprised of exercise and education designed to improve exercise tolerance, decrease perceived dyspnea, increase health-related quality of life, and promote patient self-management • Pulmonary Rehabilitation (PR) has become a standard of care for many chronic lung diseases. • COPD, asthma, pulmonary fibrosis, pulmonary hypertension, and bronchiectasis

4. Pulmonary Rehabilitation Phase II • Has been shown to decrease perceived dyspnea • Increase participant's quality of life (QoL) while actively participating in the program. • Typical length of program is 4-12 weeks • Highly dependent on patient’s level of conditioning and goals • 2-3 sessions per week • Must be initiated via physician referral

5. Pulmonary Rehabilitation Phase III(Maintenance) • Option for graduates of a Phase II program • Patients pay a monthly membership fee • able to utilize the rehabilitation facility to exercise and attend education classes

6. Design • Retrospective cohort study comparing patients who graduated PR, and enrolled in the Phase III maintenance program, to a similar set of patients who chose to exercise on their own after graduation • Patients were recruited from 2 hospital-based, outpatient PR programs in the Carolinas HealthCare System • Must have completed at least 4 weeks of the PR program

7. Process • Measures for comparison • healthcare utilization • 6 months pre/post PR graduation • Data pulled from EMR • perceived QoL as it relates to their chronic lung disease • Measured via St. George Respiratory Questionnaire post PR graduation and current • dyspnea management • Measured via MMRC post PR graduation and current

8. Healthcare Utilization • A decrease of 72% is noted in hospitalizations in the Phase III group pre- and post-rehabilitation and a 50% decrease in ER/UC visits • The non-Phase III group shows a 50% decrease in hospitalizations and a 75% decrease in ER/UC visits.

9. Healthcare Related Quality of Life • St. George Respiratory Questionnaire • Measures 3 QoL domains • Symptoms • Activity • Impact • Decrease of 4 units or more in the total score is considered clinically meaningful improvement

10. Dyspnea Management • Medical Research Council’s (MMRC) five-point dyspnea scale is used to objectively quantify each patient’s level of dyspnea and is used as a “functional evaluation” • A decrease in MMRC score is considered a reduction in dyspnea

11. Dyspnea Management • There was no change noted in MMRC scores in either group • Both groups reported an average MMRC score of 2

12. Conclusion • Patients, whether attending Phase III Pulmonary Rehabilitation or not, both show a decrease in healthcare utilization 6 months after completion of a Pulmonary Rehabilitation program. • Continued exercise is beneficial to all patients, regardless of venue. • While the St. George’s Respiratory Questionnaire helps to quantify how a patient’s chronic respiratory disease affects their quality of life, it did not adequately correspond with patient’s perceived overall health.

13. Conclusion • Natural disease progression continues to affect this patient population and how they manage the symptoms of their disease and their activity levels. • More studies, with longer duration, is needed to determine how beneficial enrollment into a Phase III pulmonary rehabilitation program can be to a patient’s health-related quality of life.

14. Questions?? Thank you!