Abstract
PURPOSE: To measure respiratory health and respiratory-related (RR) health care utilization in veterans with chronic obstructive pulmonary disease referred to pulmonary rehabilitation (PR) at the Cincinnati Veterans Administration (VA) Medical Center.
METHODS: We reviewed the records of 430 patients referred for PR from 2008 to 2010: 78 met inclusion criteria and completed PR (PR group); 92 qualified for PR but declined participation (referral group). All PR participants completed the St. George's Respiratory Questionnaire (SGRQ), BODE index, 6-minute walk test (6MWT), UCSD Shortness of Breath Questionnaire (UCSDSOBQ), Pulmonary Disease Knowledge Test, and self-reported use of short-acting bronchodilators before and after PR. All VA health care encounters during the 12 months before and after PR (PR group) or referral (referral group) were reviewed.
RESULTS: Respiratory health improved after PR: SGRQ (60.6 +/- 15.1, 51.1 +/- 16.7), BODE (4.65 +/- 1.93, 3.41 +/- 1.84), 6MWT (497 +/- 367 m, 572 +/- 397 m), UCSDSOBQ (68.3 +/- 21.1, 61.0 +/- 20.9), Pulmonary Disease Knowledge Test (75.9 +/- 12.4%, 85.9 +/- 11.1%), short-acting bronchodilator (22.5 +/- 25.3, 12.8 +/- 15.6 inhalations per week) (before, after PR; P < .001 for all comparisons). The RR emergency department (ED) visits (0.71 +/- 1.44, 0.44 +/- 0.86; P = .04) and RR hospitalizations (0.41 +/- 0.73, 0.23 +/- 0.51; P = .03) (visits/patient/year; pre-PR, post-PR) decreased following PR. RR ED visits and hospitalizations were the same for the PR and referral groups prior to PR but declined post-PR (0.44 +/- 0.86, 0.78 +/- 1.36 ED visits/patient/year; P = .05) and (0.23 +/- 0.51, 0.59 +/- 1.20 hospitalizations/patient/year; P = .01). Ninety-four percent of PR participants achieved the minimal clinically important difference in at least 1 univariate scale (Modified Medical Research Council, UCSDSOBQ, SGRQ, and 6MWT); 82%, 2 scales; 59%, 3 scales; and 24%, all 4 scales.
CONCLUSIONS: Pulmonary rehabilitation improves respiratory health in veterans with chronic obstructive pulmonary disease and decreases RR health care utilization.