Despite proven benefits, the proportion of people with COPD who receive Pulmonary Rehabilitation (PR) is very small. The current model of a center-based PR program fails to address the needs of many patients with COPD. The most common patient barrier to attendance is travel to center-based programs, particularly for frail patients with more severe COPD who need transportation assistance. Home-based, unsupervised PR has been proposed as an alternative model to hospital-based programs and has been found to be safe and effective. In particular PR post-hospitalization has been reported as the most effective intervention to prevent a hosptal readmission; however, the reality is that many times this is not a feasible intervention as only 4% of eligible individuals are able to adhere to PR after a hospital admission (for multiple reasons). While COPD is responsible for nearly 700,000 hospitalizations annually, many of these hospitalizations, which account for a large proportion of the annual direct medical costs of COPD, are potentially preventable readmissions. In this award we plan to add Health Coaching to PR to promote a behavior change based on our previous work (R01 HL09468), that was shown to be highly effective to decrease COPD re-hospitalizations and sustainably improve QOL. We propose a simple system of Remote PR that may fill the practice gap based on our previous work (R44 HL114162; Kramer, PI; Benzo). A refined home-based PR will be tested in a well-powered phase 2 randomized clinical trial of 150 patients that will be started in the R61 period and finalized in the R33 period.
Pulmonary Rehabilitation (PR) is a critical part of chronic obstructive pulmonary disease (COPD) treatment, reducing breathlessness, increasing health-related quality of life (QOL), and decreasing healthcare utilization. However, only a small portion of patients with COPD complete PR, mostly due to access issues or frailty. In this application we propose to test the effectiveness of a home-based PR program developed in our previous NIH awards that aims to improve program adherence, QOL, daily physical activity, and healthcare utilization.
