Pulmonary Rehabilitation and Readmission Rates for Medicare Beneficiaries with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Rationale Clinical trials outside of the United States have assessed whether pulmonary rehabilitation (PR) decreases readmission rates for chronic obstructive pulmonary disease (COPD). We investigated if PR was associated with lower readmission risk for Medicare patients hospitalized for COPD. Methods We identified adults enrolled in Medicare hospitalized for COPD exacerbation from a random sample of 5 million Medicare beneficiaries (2010-2012). Patients received PR if they attended ≥1 outpatient session. A cohort was identified to study non-elective 30-day all-cause readmissions; a subcohort was identified to study 1-year all-cause readmission. We used stabilized inverse probability weights to balance groups by patient demographics, comorbidities, frailty, smoking status and long-term oxygen use. We performed cause-specific regression with death as a competing risk. Results Of 1,839,827 hospitalizations from 2011-2012, we identified 78,074 for COPD. The 30-day cohort contained 7,825 COPD index hospitalizations, of which 235 (3%) received PR; one-year cohort contained 3,401, of which 108 (3%) received PR. The median number of PR sessions was 3 (IQR 1-11) for both cohorts. There were fewer deaths in 30-day PR group (9 versus 18/100 patients at risk, P<0.001) and 1-year PR group (<11 versus 36/100 patients at risk, P<0.001). Hazard ratio for 30-day readmission was 0.47 (95% CI 0.33-0.68, P<0.0001). Hazard ratio for 1-year readmission was 1.45 (95% CI 1.19-1.76, P<0.001). Conclusions This is one of the first studies of PR and readmissions in Medicare patients. We found that PR was associated with lower risk of 30-day all-cause readmissions but higher risk of 1-year all-cause readmission.