title: A Pulmonary Rehabilitation Decisional Score to Define Priority Access for COPD Patients.
abstract: This retrospective study aimed to evaluate, through an ad hoc 17-item tool, the Pulmonary Rehabilitation Decisional Score (PRDS), the priority access to PR prescription by respiratory specialists. The PRDS, scoring functional, clinical, disability, frailty, and participation parameters from 0 = low priority to 34 = very high priority for PR access, was retrospectively calculated on 124 specialist reports sent to the GP of subjects (aged 71 ± 11 years, FEV1%  51 ± 17) consecutively admitted to our respiratory outpatient clinic. From the specialist's report the final subject's allocation could be low priority (LP) (>60 days), high priority (HP) (30-60 days), or very high priority (VHP) (<30 days) to rehabilitation. The PRDS calculation showed scores significantly higher in VHP versus LP (p< 0.001) and significantly different between HP and VHP (p< 0.001). Comparing the specialist's allocation decision and priority choice based on PRDS cut-offs, PR prescription was significantly more appropriate in VHP than in HP (p= 0.016). Specialists underprescribed PR in 49% of LP cases and overprescribed it in 46% and 30% of the HP and VHP prescriptions, respectively. A multicomprehensive score is feasible being useful for staging the clinical priorities for PR prescription and facilitating sustainability of the health system.
authors.affiliation: Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Lumezzane, Brescia, Italy.
authors.forename: Michele
authors.identifier: 0000-0002-9389-7915
authors.initials: M
authors.lastname: Vitacca
authors.affiliation: Health Directorate, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Lumezzane, Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Comini
authors.affiliation: Health Directorate, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Lumezzane, Brescia, Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Barbisoni
authors.affiliation: Health Directorate, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Lumezzane, Brescia, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Francolini
authors.affiliation: Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Lumezzane, Brescia, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Paneroni
authors.affiliation: Health Directorate, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Lumezzane, Brescia, Italy.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Ramponi