1. Pulmonary Rehabilitation
Evaluation of the Benefits of Phase III (Maintenance) Pulmonary Rehabilitation on Participants Healthcare Quality of Life and Healthcare Utilization
Charley P. Starnes, BSRT, RRT, RCP

2. Purpose
To determine if continued exercise (enrollment in a pulmonary rehabilitation maintenance program) after graduation from a medically-supervised program decreases healthcare utilization, i.e. ER visits/hospitalizations, and maintains/increases participant’s perceived quality of life and dyspnea management

3. Pulmonary Rehabilitation Phase II
Medically-supervised, outpatient program comprised of exercise and education designed to improve exercise tolerance, decrease perceived dyspnea, increase health-related quality of life, and promote patient self-management
Pulmonary Rehabilitation (PR) has become a standard of care for many chronic lung diseases.
COPD, asthma, pulmonary fibrosis, pulmonary hypertension, and bronchiectasis

4. Pulmonary Rehabilitation Phase II
Has been shown to decrease perceived dyspnea
Increase participant's quality of life (QoL) while actively participating in the program.
Typical length of program is 4-12 weeks
Highly dependent on patient’s level of conditioning and goals
2-3 sessions per week
Must be initiated via physician referral

5. Pulmonary Rehabilitation Phase III (Maintenance)
Option for graduates of a Phase II program
Patients pay a monthly membership fee
able to utilize the rehabilitation facility to exercise and attend education classes

6. Design
Retrospective cohort study comparing patients who graduated PR, and enrolled in the Phase III maintenance program, to a similar set of patients who chose to exercise on their own after graduation
Patients were recruited from 2 hospital-based, outpatient PR programs in the Carolinas HealthCare System
Must have completed at least 4 weeks of the PR program

7. Process Measures for comparison healthcare utilization
6 months pre/post PR graduation
Data pulled from EMR
perceived QoL as it relates to their chronic lung disease
Measured via St. George Respiratory Questionnaire post PR graduation and current
dyspnea management
Measured via MMRC post PR graduation and current

8. Healthcare Utilization
A decrease of 72% is noted in hospitalizations in the Phase III group pre- and post-rehabilitation and a 50% decrease in ER/UC visits
The non-Phase III group shows a 50% decrease in hospitalizations and a 75% decrease in ER/UC visits.

9. Healthcare Related Quality of Life
St. George Respiratory Questionnaire
Measures 3 QoL domains
Symptoms
Activity
Impact
Decrease of 4 units or more in the total score is considered clinically meaningful improvement

10. Dyspnea Management
Medical Research Council’s (MMRC) five-point dyspnea scale is used to objectively quantify each patient’s level of dyspnea and is used as a “functional evaluation”
A decrease in MMRC score is considered a reduction in dyspnea

11. Dyspnea Management
There was no change noted in MMRC scores in either group
Both groups reported an average MMRC score of 2

12. Conclusion
Patients, whether attending Phase III Pulmonary Rehabilitation or not, both show a decrease in healthcare utilization 6 months after completion of a Pulmonary Rehabilitation program.
Continued exercise is beneficial to all patients, regardless of venue.
While the St. George’s Respiratory Questionnaire helps to quantify how a patient’s chronic respiratory disease affects their quality of life, it did not adequately correspond with patient’s perceived overall health.

13. Conclusion
Natural disease progression continues to affect this patient population and how they manage the symptoms of their disease and their activity levels.
More studies, with longer duration, is needed to determine how beneficial enrollment into a Phase III pulmonary rehabilitation program can be to a patient’s health-related quality of life.

14. Questions?? Thank you!