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April 12, 2019

Video Telehealth Pulmonary Rehabilitation Cut Risk of 30-Day Readmission in Patients with COPD

Wallace Stephens
Video telehealth pulmonary rehabilitation intervention reduced the risk of 30-day readmission in patients with chronic obstructive pulmonary disease. 
Video telehealth pulmonary rehabilitation can reduce 30-day all-cause readmission rates for people with chronic obstructive pulmonary disease (COPD) who were hospitalized due to an acute exacerbation, according to a study in the American Journal of Respiratory and Critical Care Medicine.1

Hospitalized individuals with COPD face increased risk of readmission after discharge.2 CMS has pursued a value-based strategy to improve health outcomes for these patients by linking payments with quality of care. The agency financially rewarded hospitals with low rates of readmission and penalized those with high rates.3 While access to pulmonary rehabilitation remains limited, this intervention has been shown to reduce hospitalizations among patients with COPD.4

"Participating in an exercise program soon after hospitalization for an acute exacerbation of COPD is associated with a substantially lower readmission rate within 30 days of discharge,” Surya P. Bhatt, MD, the study's lead author and an associate profesor in the Division of Pulmonary, Allergy and Critical Care Medicine at the University of Alabama-Birmingham School of Medicine, said in a statement.“The video telehealth pulmonary rehabilitation program, by overcoming many barriers to early initiation of pulmonary rehabilitation, can expand access to pulmonary rehabilitation, especially for patients who live in rural areas."

Researchers conducted the study to examine whether video telehealth pulmonary rehabilitation intervention soon after discharge could effectively reduce 30-day all-cause readmission rates of patients with COPD who were admitted due to an exacerbation.

Patients were recruited at a single, quaternary care, academic hospital. At total of 240 participants were included, including 80 who received video pulmonary rehabilitation and 160 who comprised the study’s control group. Cases were matched 1-to-2 by risk of readmission determined by the LACE Index (length of stay, acuity, comorbidities, and emergency room visits in the past 6 months). Both groups had similar demographics and comorbidities. However, a greater proportion of patients that received the video pulmonary rehabilitation intervention were on domiciliary oxygen.

The real-time videoconferencing pulmonary rehabilitation intervention began 2 weeks after a patient was discharged and included a standardized regimen of 36 exercise sessions for a period of 12 weeks. The regimen was prescribed by an exercise physiologist and was adjusted according to patients’ initial outpatient exercise assessments, baseline functional levels, and levels of impairment before an exacerbation.

The exercise regimen included combinations of stretching and breathing exercises followed by 20 minutes of aerobic exercises using a portable foot peddler that was provided to the treatment group. The goal of the intervention was to bring patients’ heart rates between 60% to 80% of the maximum rate recorded at baseline after a 6-minute walk test.

While the study’s primary outcome was 30-day all-cause rate of readmission, the secondary outcome included 30-day readmission rates due to acute exacerbations of COPD as well as time passed between discharge and readmission due to any cause.

Researchers found the rate of 30-day all-cause readmission among participants who received video telehealth pulmonary rehabilitation intervention significantly lower than the control group; the rate was 18.1% for the control group and 6.2% for the intervention group. The 30-day rate of readmission due to an acute exacerbation of COPD was lower in the treatment group (3.8%) than in the control group (11.9%). The time before first readmission was longer for the group that received telehealth pulmonary rehabilitation (265 days vs 211 days).

While the results were encouraging, researchers stated that they must be confirmed by a randomized clinical trial.

“By reducing COPD readmissions, this intervention has the potential to substantially reduce health care costs,” Bhatt said.

Reference

1. Bhatt SP, Patel SB, Anderson EM, et al. Video telehealth pulmonary rehabilitation intervention in COPD reduces 30-day readmissions. [published online April 12, 2019] Am J Respir Crit Care Med. doi: 10.1164/rccm.201902-0314LE.

2. Rezaee ME, Ward CE, Nuanez B, Rezaee DA, Ditkoff J, Halalau A. Examining 30-day COPD readmissions through the emergency department. Int J Chron Obstruct Pulmon Dis. 2017;13:109–120. doi:10.2147/COPD.S147796.

3. Hospital Readmissions Reduction Program (HRRP). CMS.gov. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html#. Published January 16, 2019. Accessed May 9, 2019.

4. Corhay JL, Dang DN, Van Cauwenberge H, Louis R. Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy. Int J Chron Obstruct Pulmon Dis. 2013;9:27–39. doi:10.2147/COPD.S52012.

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