title: Impact of pulmonary rehabilitation on hospitalizations for chronic obstructive pulmonary disease among members of an integrated health care system.
abstract: OBJECTIVE
  The evidence regarding the effects of pulmonary rehabilitation (PR) on health care resource use remains limited. This retrospective study evaluated the effects of PR on the primary outcome of all-cause hospitalizations and secondary outcomes of other health care use, exercise capacity, health-related quality of life (HRQOL), and body weight in patients with chronic obstructive pulmonary disease (COPD) in a large integrated health care system.
  
  
  METHODS
  The PR cohort included 558 patients with a COPD diagnosis, age ≥ 40 years, who were treated with a bronchodilator or steroid inhaler, participated in 1 of 13 PR programs between January 1, 2008, and August 1, 2013, and were continuously enrolled in the health plan ≥ 12 months prior to and after PR. Two non-PR control cohorts were assembled for comparison. Data were extracted from electronic health records. The 6-minute walk test and St. George's Respiratory Questionnaire results were available for a subset.
  
  
  RESULTS
  The proportion of patients who were hospitalized 12 months post-PR was lower compared with the 12 months prior (37% vs 45%, P = .001) while emergency department use was not different (52% vs 54%). Patients who declined PR for logistical reasons had a 40% higher risk of hospitalization than PR participants (relative risk = 1.40, 95% CI: 0.96-2.06, P = .08). There were significant improvements in the 6-minute walk test distance (+43 m) and the St. George's Respiratory Questionnaire total score (-9.6 points) but minimal changes in weight.
  
  
  CONCLUSIONS
  Our finding that participation in PR is associated with reductions in hospitalizations corroborates previous studies. A notable strength of this study is the capture of complete utilization data.
authors.affiliation: Department of Research and Evaluation (Drs Nguyen and Gould and Mss Liu and Lee), and Pulmonary and Critical Care, Kaiser Permanente Southern California (Dr Harrington), Pasadena.
authors.forename: Huong Q
authors.initials: HQ
authors.lastname: Nguyen
authors.forename: Annie
authors.initials: A
authors.lastname: Harrington
authors.forename: In-Lu Amy
authors.initials: IL
authors.lastname: Liu
authors.forename: Janet S
authors.initials: JS
authors.lastname: Lee
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gould
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000534:rehabilitation*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016138:Walking
chemical_list: D001993:Bronchodilator Agents