Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease.
Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease.
复制标题
慢性阻塞性肺疾病住院患者启动肺康复治疗与再住院情况的相关性
DOI：
10.1164/rccm.202012-4389oc
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发表时间：
2021-11-01
影响因子：
24.7
通讯作者：
Lindenauer PK
中科院分区：
文献类型：
--
作者：
Stefan MS;Pekow PS;Priya A;ZuWallack R;Spitzer KA;Lagu TC;Pack QR;Pinto-Plata VM;Mazor KM;Lindenauer PK
基本原理：尽管临床试验发现肺康复（PR）可以降低慢性阻塞性肺疾病（COPD）加重住院后再入院的风险，但对PR在常规临床实践中的影响知之甚少。 目的：评价出院后90天内开始PR与再住院之间的关系。 研究方法：我们分析了2014年因COPD住院的医疗保险受益人（66岁或以上）的回顾性队列，这些受益人在出院后至少存活了30天。 测量和主要结果：我们使用倾向评分匹配，并使用多状态模型估计1年时复发性全因再住院的风险，以解释死亡的竞争风险。在4，446家医院住院的197，376例患者中，2，721例患者（1.5%）在出院后90天内启动了PR。总体而言，1，534例（56.4%）启动PR的患者和125，720例（64.6%）未启动PR的患者在出院后1年内再次住院一次或多次。在倾向评分匹配分析中，PR启动与PR启动后一年内再入院风险较低相关（风险比，0.83; 95%置信区间，0.77-0.90）。在90天内开始PR的患者1年时再住院的平均累积次数为0.95，而未开始PR的患者为1.15（P < 0.001）。 结论：在因COPD住院治疗后，在出院后90天内启动PR的医疗保险受益人在1年内的再住院次数较少。这些结果支持随机对照临床试验的结果，并强调需要确定有效的策略，以增加PR参与。
Rationale: Although clinical trials have found that pulmonary rehabilitation (PR) can reduce the risk of readmissions after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, less is known about PR’s impact in routine clinical practice. Objectives: To evaluate the association between initiation of PR within 90 days of discharge and rehospitalization(s). Methods: We analyzed a retrospective cohort of Medicare beneficiaries (66 years of age or older) hospitalized for COPD in 2014 who survived at least 30 days after discharge. Measurements and Main Results: We used propensity score matching and estimated the risk of recurrent all-cause rehospitalizations at 1 year using a multistate model to account for the competing risk of death. Of 197,376 total patients hospitalized in 4,446 hospitals, 2,721 patients (1.5%) initiated PR within 90 days of discharge. Overall, 1,534 (56.4%) patients who initiated PR and 125,720 (64.6%) who did not were rehospitalized one or more times within 1 year of discharge. In the propensity-score–matched analysis, PR initiation was associated with a lower risk of readmission in the year after PR initiation (hazard ratio, 0.83; 95% confidence interval, 0.77–0.90). The mean cumulative number of rehospitalizations at 1 year was 0.95 for those who initiated PR within 90 days and 1.15 for those who did not (P < 0.001). Conclusions: After hospitalization for COPD, Medicare beneficiaries who initiated PR within 90 days of discharge experienced fewer rehospitalizations over 1 year. These results support findings from randomized controlled clinical trials and highlight the need to identify effective strategies to increase PR participation.