Pulmonary Rehabilitation Is Associated With Decreased Exacerbation and Mortality in Patients With COPD

医学恶化慢性阻塞性肺病死亡率肺康复康复入射（几何）间接成本慢性阻塞性肺病加重期医疗费用医疗保健内科学急诊医学重症监护医学物理疗法慢性阻塞性肺疾病急性加重期会计光学物理业务经济增长经济

作者

Joon Young Choi,Ki Uk Kim,Deog Kyeom Kim,Yu‐Il Kim,Tae‐Hyung Kim,Won‐Yeon Lee,Seoung Ju Park,Yong Bum Park,Jin Woo Song,Kyeong‐Cheol Shin,Soo‐Jung Um,Kwang Ha Yoo,Hyoung Kyu Yoon,Chang Youl Lee,Ho Sung Lee,Ah Young Leem,Won-Il Choi,Seong Yong Lim,Chin Kook Rhee

出处

期刊：Chest [Elsevier]
日期：2023-10-06 卷期号：165 (2): 313-322 被引量：8

链接

nih.govdoi.org

标识

DOI：10.1016/j.chest.2023.09.026

摘要

Background

Poor uptake to pulmonary rehabilitation (PR) is still challenging around the world. There have been few nationwide studies investigating whether PR impacts patient outcomes in COPD. We investigated the change of annual PR implementation rate, medical costs, and COPD outcomes including exacerbation rates and mortality between 2015 and 2019.

Research Question

Does PR implementation improve outcomes in patients with COPD in terms of direct cost, exacerbation, and mortality?

Study Design and Methods

Data of patients with COPD extracted from a large Korean Health Insurance Review and Assessment service database (2015-2019) were analyzed to determine the trends of annual PR implementation rate and direct medical costs of PR. Comparison of COPD exacerbation rates between pre-PR and post-PR, and the time to first exacerbation and mortality rate according to PR implementation, were also assessed.

Results

Among all patients with COPD in South Korea, only 1.43% received PR. However, the annual PR implementation rate gradually increased from 0.03% to 1.4% during 4 years, especially after health insurance coverage commencement. The direct medical cost was significantly higher in the PR group than the non-PR group, but the costs in these groups showed decreasing and increasing trends, respectively. Both the incidence rate and frequency of moderate-to-severe and severe exacerbations were lower during the post-PR period compared with the pre-PR period. The time to the first moderate-to-severe and severe exacerbations was longer in the PR group than the non-PR group. Finally, PR implementation was associated with a significant decrease in mortality.

Interpretation

We concluded that health insurance coverage increases PR implementation rates. Moreover, PR contributes toward improving outcomes including reducing exacerbation and mortality in patients with COPD. However, despite the well-established benefits of PR, its implementation rate remains suboptimal.