SESSION TITLE: Lung, Exercise and Aging
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 27, 2013 at 10:45 AM - 11:45 AM
PURPOSE: Pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD) has been shown to improve symptoms, exercise performance, health-related quality of life (HRQL) and health care utilization. In 2002, Medicare began reimbursement for pulmonary rehabilitation programs. Clinical practice guidelines (GOLD, ATS/ERS) for COPD recommend PR in patients with moderate or more severe disease and persistent symptoms despite optimal medical management. National trends in the use of pulmonary rehabilitation in older adults with COPD are not known. We examined the trends in use of pulmonary rehab among 5% national sample of Medicare patients with COPD between 2003 and 2009.
METHODS: We did a retrospective cross-sectional study of COPD patients who received PR from 2003 to 2009. A diagnosis of COPD was determined by two outpatient claims with international Classification of Diseases, 9th ed (ICD-9) code 491.xx, 492.xx, or 496 or one inpatient claim with primary discharge diagnosis of respiratory failure defined by ICD-9 code 518.81, 518.82, 518.84 and secondary diagnosis for COPD. Pulmonary rehabiliation sessions were identified by CMS codes G0237, G0238, G0239, 97001, 97003, 97110, 97115, 97124, 97129, 97150, 97530, 97535, 97537. The primary outcome was percent receiving PR per calendar year. We also determine the number of PR sessions per beneficiary for each calendar year. A Cochran Armitage trend test was performed. All p-values <0.05 was considered statistically significant.
RESULTS: Pulmonary rehabilitation use among older adults with COPD increased from 2.78% in 2003 to 3.74% in 2009, p-value<0.0001. The number of PR sessions per beneficiary for each calendar year for patients who had 1-4 sessions declined over time (67% in 2003 to 58.5% in 2009). The proportion of patients completing >8 sessions almost doubled from 8.2% in 2003 to 16.2% in 2009.
CONCLUSIONS: Pulmonary rehabilitation use in older adults with COPD has increased modestly during the study period.
CLINICAL IMPLICATIONS: This is the first national study to identify trends in pulmonary rehabilitation. Use of PR remains low despite clinical practice guidelines and significant evidence showing improvements in patient centered outcomes.
DISCLOSURE: The following authors have nothing to disclose: Shawn Nishi, Anita Mercado, Wei Zhang, Yong-Fang Kuo, Gulshan Sharma
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