<p>Effectiveness and Economic Evaluation of Hospital-Outreach Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease</p>

Abstract

Objective: Hospital-outreach pulmonary rehabilitation (PR) can improve health status and reduce health-care utilization by patients with chronic obstructive pulmonary disease (COPD). However, its long-term effects and costs versus benefits are still not clear. This study was conducted to develop, deliver, and evaluate the effects and monetary savings of a hospital-outreach PR program for patients with COPD. Methods: A randomized controlled trial was conducted. Patients with COPD (n=208) were randomly assigned to the hospital-outreach PR program (treatment) or treatment as usual (control). The treatment group received a 3-month intensive intervention, including supervised physical exercise, smoking cessation, self-management education, and psychosocial support, followed by long-term access to a nurse through telephone follow-up and home visits up to 24 months. The control group received routine care, including discharge education and a self-management education brochure. Main outcomes were collected at 3, 6, 12, and 24-months postrandomization. Primary outcomes included health-care utilization (ie, readmission rates, times, and days, and emergency department visits) and medical costs. Secondary outcomes included lung function (ie, FEV 1 , FEV 1 % predicted, FVC), dyspnea (mMCR), exercise capacity (6MWD), impact on quality of life (CAT), and self-management (CSMS). Results: At the end of 24 months, 85 (81.7%) in the treatment group and 89 (85.6%) in the control group had completed the whole program. Compared with the control group, patients in the treatment group had lower readmission rates, times, and days at 6 and 12 months and during 12-24 months. Regarding costs during the 2 years, the program achieved CN¥3,655.94 medical savings per patient per year, and every ¥1 spent on the program led to ¥3.29 insavings. Patients in the treatment group achieved improvements in FEV 1 , FEV 1 % predicted, exercise capacity, and self-management. It also achieved relief of dyspnea symptoms and improvement in COPD's impact on quality of life. Conclusion: The hospital-outreach PR program for patients with COPD achieved reductions in health-care utilization, monetary savings, and improvements in patient health outcomes. The effects of the program were sustained for at least 2 years. Trial Registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-TRC-14005108).

Smoking Cessation Interventions for Patients With Chronic Obstructive Pulmonary Disease

“…Two studies that examined smoking interventions delivered during PR were ultimately not included in the main review: one study enrolled current smokers with and with no COPD and no subgroup analysis focused on patients with COPD, 12 and the second study did not report smoking abstinence rates. 43 Research in this area would be helpful to providers developing or refining PR programs to meet the diverse needs of patients. Finally, although this study provides a detailed, narrative review of smoking interventions for patients with COPD with discussion on how such interventions may be incorporated into PR, no quantitative methods were used to evaluate aggregated effects of intervention, examine possible moderators, or assess study quality as such efforts have been reported elsewhere.…”

“…As noted previously, none of the studies included in this review examined smoking cessation interventions delivered within the context of PR. Two studies that examined smoking interventions delivered during PR were ultimately not included in the main review: one study enrolled current smokers with and with no COPD and no subgroup analysis focused on patients with COPD,12 and the second study did not report smoking abstinence rates 43. Research in this area would be helpful to providers developing or refining PR programs to meet the diverse needs of patients.…”

Effects of home‐based telehealth on the physical condition and psychological status of patients with chronic obstructive pulmonary disease: A systematic review and meta‐analysis

“…A total of 32 studies met all of the eligibility criteria and were included in this meta‐analysis (Bernocchi et al, 2018; Cameron‐Tucker et al, 2016; Chatwin et al, 2016; Chen et al, 2014, 2021; Demeyer et al, 2017; Jehn et al, 2013; Jiménez‐Reguera et al, 2020; Kessler et al, 2018; Lahham et al, 2020; Li et al, 2014, 2018; Ma, 2019; McDowell et al, 2015; Mínguez Clemente et al, 2020; Park et al, 2020; Pinnock et al, 2013; Rixon et al, 2017; Steele et al, 2008; Tsai et al, 2017; Tupper et al, 2018; Vasilopoulou et al, 2017; Vianello et al, 2016; Vorrink et al, 2016; Walker et al, 2018; Wang et al, 2017; Wang, Guo, et al, 2021; Wang, Di, et al, 2021; Xing et al, 2021; Yan et al, 2018; Ye et al, 2019; Zhang et al, 2020). A flow diagram of the study selection process is shown in Figure 1.…”

“…All relevant data were documented in the electronic health records to allow the administrators and patients to refer to relevant information using the internet (Wang et al, 2017). In 15 studies, patients in the intervention groups received multicomponent telehealth, including telerehabilitation, telemonitoring, and self‐management programmes (Chen et al, 2014, 2021; Demeyer et al, 2017; Jiménez‐Reguera et al, 2020; Kessler et al, 2018; Lahham et al, 2020; Ma, 2019; Park et al, 2020; Vorrink et al, 2016; Wang, Di, et al, 2021; Wang, Guo, et al, 2021; Xing et al, 2021; Yan et al, 2018; Ye et al, 2019; Zhang et al, 2020). The duration of home‐based telehealth interventions ranged from 8 weeks to 24 months.…”

“…The authors of 25 studies (Cameron‐Tucker et al, 2016; Chen et al, 2014, 2021; Demeyer et al, 2017; Jiménez‐Reguera et al, 2020; Kessler et al, 2018; Lahham et al, 2020; Li et al, 2014; McDowell et al, 2015; Mínguez Clemente et al, 2020; Park et al, 2020; Pinnock et al, 2013; Rixon et al, 2017; Tsai et al, 2017; Tupper et al, 2018; Vasilopoulou et al, 2017; Vianello et al, 2016; Vorrink et al, 2016; Walker et al, 2018; Wang et al, 2017; Wang, Di, et al, 2021; Wang, Guo, et al, 2021; Xing et al, 2021; Ye et al, 2019; Zhang et al, 2020) reported the use of randomized sequence generation; however, the other studies (Bernocchi et al, 2018; Chatwin et al, 2016; Jehn et al, 2013; Li et al, 2018; Ma, 2019; Yan et al, 2018; Steele et al, 2008) only mentioned randomization. Given the nature of home‐based telehealth, it is not possible to blind personnel and patients.…”