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

一项混合方法研究，分析慢性阻塞性肺病住院后肺康复的使用情况，并确定提高参与率的有效策略

• 批准号: 9905417
• 负责人: Peter Kyle Lindenauer
• 金额: $ 70.32万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9905417
• 关键词: Activities of Daily Living; Acute; Affect; Cardiac rehabilitation; Case Mixes; Cause of Death; Chronic; Chronic Obstructive Airway Disease; Clinical; Clinical Practice Guideline; Data; Education; Enrollment; Ensure; Fee-for-Service Plans; Foundations; Future; Goals; Guidelines; Health system; Healthcare; Hospitalization; Hospitals; Individual; Inpatients; Institution; Insurance Coverage; Intervention; Intervention Studies; Interview; Knowledge; Link; Low income; Lung diseases; Medical; Medicare; Meta-Analysis; Methods; Modeling; National Heart, Lung, and Blood Institute; Outpatients; Patient Participation; Patient Participation Rates; Patient Readmission; Patient-Focused Outcomes; Patients; Performance; Phase; Policies; Psychosocial Assessment and Care; Public Health; Qualitative Methods; Quality of Care; Quality of life; Records; Reporting; Research; Risk; Sampling; Series; Severity of illness; Site; Site Visit; Source; Standardization; Statistical Data Interpretation; Strategic Planning; Structure; Survey Methodology; Surveys; Testing; Time; Training and Education; Translational Research; Translations; Variant; Visit; Well in self; base; behavior change; beneficiary; clinical practice; comorbidity; contextual factors; deconditioning; design; disparity reduction; evidence base; exercise capacity; exercise program; exercise training; experience; functional status; geographic difference; health care disparity; health related quality of life; high risk; hospital readmission; implementation science; implementation trial; improved; informant; innovation; insight; interest; novel; patient oriented; payment; policy implication; prevent; programs; pulmonary rehabilitation; randomized trial; readmission risk; reduce symptoms; rehabilitation service; routine screening; uptake

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.”

项目摘要/摘要

项目成果

Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease.

• DOI: 10.1164/rccm.202012-4389oc
• 发表时间: 2021-11-01
• 期刊: American journal of respiratory and critical care medicine
• 影响因子: 24.7
• 作者: Stefan MS;Pekow PS;Priya A;ZuWallack R;Spitzer KA;Lagu TC;Pack QR;Pinto-Plata VM;Mazor KM;Lindenauer PK
• 通讯作者: Lindenauer PK

"You Leave There Feeling Part of Something": A Qualitative Study of Hospitalized COPD Patients' Perceptions of Pulmonary Rehabilitation.

“你离开那里时感觉自己是某事的一部分”：住院慢性阻塞性肺病患者对肺康复看法的定性研究。

• DOI: 10.2147/copd.s234833
• 发表时间: 2020
• 期刊: International journal of chronic obstructive pulmonary disease
• 影响因子: 2.8
• 作者: Spitzer,KerryA;Stefan,MihaelaS;Drake,AubriA;Pack,QuinnR;Lagu,Tara;Mazor,KathleenM;Pinto-Plata,Victor;Lindenauer,PeterK
• 通讯作者: Lindenauer,PeterK

Promoting Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease, Strategies of Top-performing Systems: A Qualitative Study.

促进慢性阻塞性肺疾病住院后参与肺康复，最佳表现系统的策略：定性研究。

• DOI: 10.1513/annalsats.202203-237oc
• 发表时间: 2023
• 期刊: Annals of the American Thoracic Society
• 影响因子: 8.3
• 作者: Spitzer,KerryA;Stefan,MihaelaS;Priya,Aruna;Pack,QuinnR;Pekow,PenelopeS;Lagu,Tara;Mazor,Kathy;Pinto-Plata,VictorM;Bradley,Kolbi;Heineman,Brent;ZuWallack,RichardL;Lindenauer,PeterK
• 通讯作者: Lindenauer,PeterK