Hospitalization Needs During an Outpatient Rehabilitation Program for Severe Chronic Airway Obstruction

doi:10.1378/chest.70.5.606

Chest

Volume 70, Issue 5, November 1976, Pages 606-610

https://doi.org/10.1378/chest.70.5.606 Get rights and content

The number of days of hospitalization for respiratory disease following entry into an outpatient pulmonary rehabilitation program was reviewed for 44 patients with chronic airway obstruction whose hospitalization records were available for the year prior to entry into the program. A significant reduction in the number of days of hospitalization occurred in patients for each of the four years following entry into the program, compared to the year prior to therapy.

Section snippets

Materials and Methods

Over a two-year period beginning in 1966, patients with chronic airway obstruction were accepted into a new comprehensive program of care designed to provide physical rehabilitation for patients with marked disability.¹ The patients met the following criteria for selection: (1) a clinical diagnosis of emphysema, chronic bronchitis, or both, by the established clinical definitions of the American Thoracic Society¹⁰ and the Ciba Symposium;¹¹ (2) absence of other significant pulmonary disease,

Results

The 44 four-year survivors were divided into two groups; group 1 consisted of 14 patients who had hospitalization(s) in the year before entry into the program, and group 2 consisted of 30 patients who had no hospitalizations during the year before entry. The results of the spirometric tests performed on entering the program were compared between groups 1 and 2 and the remaining 69 patients of the original group of 113 who received the questionnaire regarding days of hospitalization (Table 1).

Discussion

Our study does not contain a matched control group without therapy. When initiating the treatment program, we did not believe that we could deny treatment to severely symptomatic patients seeking relief and then follow them as a control group. The decision to use the patient's experience in the year before therapy as the “control,” despite its shortcomings, seemed the best compromise when considering the difficult ethical and scientific questions involved. This method raises the possibility

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The effects of 1 year of specific inspiratory muscle training in patients with COPD
2005, Chest
Citation Excerpt :
In addition, these improvements were translated by the patients to a better quality of life following training. A previous uncontrolled and retrospective study29 found a significant decrease in hospitalization days after a rehabilitation program. However, no such differences in hospitalization days were demonstrated by others.30
Aim: We assessed the long-term benefits of inspiratory muscle training (IMT) on inspiratory muscle strength, exercise capacity, the perception of dyspnea, quality of life, primary care use, and hospitalizations in patients with significant COPD.
Patients: Forty-two consecutive COPD patients with FEV₁< 50% of predicted were randomized into a group that received IMT for 1 year, and a control group that received training with a very low load.
Results: There was a statistically significant increase in inspiratory muscle strength (at the end of the third month of training) as assessed by maximal inspiratory pressure (from 71 ± 4.9 to 90 ± 5.1 cm H₂O [Â± SEM], p < 0.005) and 6-min walk distance (at the end of the third month of training; from 256 ± 41 to 312 ± 54 m; p < 0.005), a decrease in the mean Borg score during breathing against resistance (at the end of the ninth month of training), improvement in the health-related quality-of-life scores (at the end of the sixth month of training) in the training group but not in the control group. At the end of the training year, these changes were maintained; in addition, a decrease in primary health-care use and hospitalization days was observed.
Conclusions: Our study shows that during IMT in patients with significant COPD, there is an increase in exercise capacity, improvement in quality of life, and decrease in dyspnea. Our study also provides evidence that long-term IMT can decrease the use of health services and hospitalization days.
Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: A randomised controlled trial
2000, Lancet
Citation Excerpt :
About 50% of outpatents with chronic obstructive pulmonary disease at our hospial before the study were admitted at least once in each year. Previous retrospective studies have shown a 38–55% decrease in days in hospital after rehabilitation.20–22 Realistically, we expected a 25% decrease in admission rate, which would have an important effect on health service resources.
Pulmonary rehabilitation seems to be an effective intervention in patients with chronic obstructive pulmonary disease. We undertook a randomised controlled trial to assess the effect of outpatient pulmonary rehabilitation on use of health care and patients' wellbeing over 1 year.
200 patients with disabling chronic lung disease (the majority with chronic obstructive pulmonary disease) were randomly assigned a 6-week multidisciplinary rehabilitation programme (18 visits) or standard medical management. Use of health services was assessed from hospital and general-practice records. Analysis was by intention to treat.
There was no difference between the rehabilitation (n=99) and control (n=101) groups in the number of patients admitted to hospital (40 vs 41) but the number of days these patients spent in hospital differed significantly (mean 10·4 [SD 9·7] vs 21·0 [20·7], p=0·022). The rehabilitation group had more primary-care consultations at the general practitioner's premises than did the control group (8·6 [6·8] vs 7·3 [8·3], p=0·033) but fewer primary-care home visits (1·5 [2·8] vs 2·8 [4·6], p=0·037). Compared with control, the rehabilitation group also showed greater improvements in walking ability and in general and disease-specific health status.
For patients chronically disabled by obstructive pulmonary disease, an intensive, multidisciplinary, outpatient programme of rehabilitation is an effective intervention, in the short term and the long term, that decreases use of health services.
Direct medical cost of chronic obstructive pulmonary disease in the U.S.A.
2000, Respiratory Medicine
The aim of this study was to estimate the direct medical costs of chronic obstructive pulmonary disease (COPD) in the United States using a public-payor perspective. Cost estimates were derived separately for 10 components of care using national survey databases and valued using Medicare and Medicaid reimbursement rates. COPD affects 15 million people in the U.S.A. and the total annual U.S. payment for care is $6·6billion. Approximately one-third ($2·3 billion) is due to the cost of long-term oxygen therapy, one-quarter is attributed to hospitalizations and inpatient physician services ($1·9 billion), and one-seventh ($942 million) is due to nursing home stays. Other annual costs are outpatient physician visits ($480 million), prescription medications ($462 million), home healthcare ($309 million), emergency department visits ($148 million), outpatient diagnostic procedures ($55 million) and hospice care ($28 million). The cost of COPD is therefore considerable. The significant expenditure for long-term oxygen therapy indicates that disease severity is a major driver of costs. However, the cost of hospitalizations, nursing home stays, emergency department and physician visits are not insignificant.
Effects of pulmonary rehabilitation on the survival of emphysema patients receiving long-term oxygen therapy
1999, Physiotherapy
The purpose of this study was to investigate the effect of pulmonary rehabilitation on the long-term survival rate of 116 elderly emphysema patients (average age 70.1 years) undergoing long-term oxygen therapy (LTOT), as well as to consider the influence on length of survival of additional factors such as LTOT starting age, nutrition (body mass index; BMI), and one-second forced expiratory volume (FEV₁).
The Kaplan-Meier method and the log-rank chi-square test were used to analyse the survival rate, and multiple regression analysis using Cox's proportional hazards model was employed to assess the relationship between the survival rate and a number of factors including BMI, percentage vital capacity (VC), FEV₁, and implementation of pulmonary rehabilitation.
The survival rate for the 20 patients who received pulmonary rehabilitation was significantly higher than that of the 96 patients who did not, suggesting that pulmonary rehabilitation is effective in the care of elderly LTOT patients with emphysema. Moreover, the relative risk was found to be 4.5 times less for those who received pulmonary rehabilitation, showing its influence on the survival rate to be significant, and confirming the role of pulmonary rehabilitation as a treatment of major importance for emphysema patients.

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Supported by grants HE05933 and HL07085.

Manuscript received September 22; revision accepted April 7.

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Chest

Clinical InvestigationsHospitalization Needs During an Outpatient Rehabilitation Program for Severe Chronic Airway Obstruction

Section snippets

Materials and Methods

Results

Discussion

Chest

Chest

J Chronic Dis

Med Clin North Am

Am J Med

A comprehensive care program for chronic airway obstruction: Methods and preliminary evaluation of symptomatic and functional improvement

Ann Intern Med

Clinical Investigations
Hospitalization Needs During an Outpatient Rehabilitation Program for Severe Chronic Airway Obstruction