A mixed methods study to analyze the use of pulmonary rehabilitation following hospitalization for COPD, and to identify effective strategies for increasing rates of participation

项目总结/摘要 慢性阻塞性肺疾病（COPD）影响美国1500万至2400万人，是美国的 疾病的恶化导致每年约70万人住院。患者 需要住院治疗的患者的功能状态和健康相关的生活质量严重下降， 可能要好几个月才能恢复肺康复（PR）是一套结构化的干预措施，包括 运动训练，教育，行为改变和支持，旨在改善身体和心理 慢性呼吸道疾病患者的健康。证据表明PR对患者的益处 稳定期COPD的发病率已经持续了几十年然而，近年来，随机试验 表明在急性发作期间或之后不久启动PR可增加功能状态， 再住院治疗，提高生存率。现在强烈建议在急性加重后开始PR， 临床指南。认识到它的许多好处，医疗保险开始为公关提供保险 2010年，我院对中重度COPD患者进行了治疗。虽然这一具有里程碑意义的政策的临床影响 我们的初步数据表明，只有一小部分潜在的合格者 个人正在接受治疗。此外，这些数据表明，参与率差异很大， 在医院中，用于促进患者参与的策略也是如此。 我们的长期目标是通过优化参与PR来改善COPD患者的生活质量。 本提案的目的是分析医疗保险中PR转化为常规临床实践的情况 受益人住院治疗COPD，并确定因素和策略，使一些 医院的参与率要高于其他医院。该研究将在2 阶段。第一阶段（目标1）包括一系列纵向和横截面多变量分析 使用链接的Medicare文件。这项研究将填补我们对PR吸收的理解中的主要空白 住院后，将提供新的见解有关潜在的差距，在照顾，将描述和分析 地理变异的来源，并将确定一组医院与非常高和非常低的比率， 第二阶段（目标2和3）涉及定性和调查相结合的应用。 方法来完善，产生，并随后测试有关上下文因素和策略的假设， 使一些医院能够比其他医院更成功地让患者参与PR。这些 活动高度响应NHLBI战略计划“推进转化研究”的目标， 具体而言，“促进创新，加快研究成果转化、知识传播， “科学发展，促进公共卫生”。

PROJECT SUMMARY / ABSTRACT Chronic obstructive pulmonary disease (COPD) affects 15 to 24 million individuals in the US, is the nation's third leading cause of death, and exacerbations result in some 700,000 annual hospital admissions. Patients who require hospitalization suffer profound reductions in functional status and health-related quality of life that can take months to recover from. Pulmonary rehabilitation (PR) is a structured set of interventions that includes exercise training, education, behavior change and support, designed to improve the physical and psychological well-being of patients with chronic respiratory disease. Evidence demonstrating the benefits of PR for patients with stable COPD has been accruing for decades. However, in more recent years, randomized trials have shown that initiating PR during or soon after an exacerbation increases functional status, prevents rehospitalization, and improves survival. Starting PR after an exacerbation is now strongly recommended in clinical guidelines. Recognizing its many benefits, Medicare began providing insurance coverage for PR services in 2010 to patients with moderate-to-severe COPD. While the clinical impact of this landmark policy decision remains largely unknown, our preliminary data suggest that only a small fraction of potentially eligible individuals are receiving treatment. Additionally, these data suggest that rates of participation vary widely across hospitals, as do the strategies used to promote patient participation. Our long-term goal is to improve the quality of life of patients with COPD by optimizing participation in PR. The objective of this proposal is to analyze the translation of PR into routine clinical practice among Medicare beneficiaries following hospitalization for COPD, and to identify the factors and strategies that enable some hospitals to achieve higher rates of participation than others. The proposed research will be carried out in 2 phases. The first phase (Aim 1) consists of a series of longitudinal and cross-sectional multivariable analyses using linked Medicare files. This research will close major gaps in our understanding of the uptake of PR following hospitalization, will provide novel insights about potential disparities in care, will describe and analyze sources of geographic variation, and will identify a group of hospitals with very high and very low rates of participation in PR. The second phase (Aims 2 and 3) involves the application of mixed qualitative and survey methods to refine, generate, and subsequently test hypotheses about the contextual factors and strategies that enable some hospitals to be more successful at getting patients to participate in PR than others. These activities are highly responsive to the NHLBI Strategic Plan goal to “Advance Translational Research”, specifically, “To facilitate innovation and accelerate research translation, knowledge dissemination, and implementation science that enhances public health.”