Participation in Pulmonary Rehabilitation Following Hospitalization for COPD among Medicare Beneficiaries

RATIONALE: Current guidelines recommend pulmonary rehabilitation (PR) after hospitalization for a COPD exacerbation, but little is known about its adoption or factors associated with participation. OBJECTIVES: To evaluate receipt of PR after a hospitalization for COPD exacerbation among Medicare beneficiaries and identify individual- and hospital-level predictors of PR receipt and adherence. METHODS: We identified individuals hospitalized for COPD during 2012 and recorded receipt, timing, and number of PR visits. We used generalized estimating equation models to identify factors associated with initiation of PR within 6 months of discharge and examined factors associated with number of PR sessions completed. RESULTS: Of 223,832 individuals hospitalized for COPD, 4,225 (1.9%) received PR within 6 months of their index hospitalization and 6,111 (2.7%) within 12 months. Median time from discharge until first PR session was 95 days (IQR 44 - 190) and median number of sessions completed was 16 (IQR 6-25). The strongest factor associated with initiating PR within 6 months was prior home oxygen use (OR: 1.49; 95% CI: 1.39 - 1.59). Individuals aged 75-84 and 85 and over (0R: 0.71; 95% CI: 0.66 - 0.76; OR: 0.25; 95% CI: 0.22 -0.29), those living over 10 miles from a PR facility (OR: 0.47; CI: 0.42 - 0.51) and those with lower SES (OR: 0.42; 95% CI 0.38 - 0.46) were less likely to receive PR. CONCLUSIONS: Two years after Medicare began providing coverage for PR, participation rates following hospitalization were extremely low. This highlights the need for strategies to increase participation