Decreasing Disparity in Lung Disease: Pulmonary Rehabilitation for Rural Patients with COPD

PROJECT SUMMARY Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Globally, COPD prevalence is estimated to be 11.7%, and COPD is the fourth leading cause of death in the United States (US). The age-adjusted prevalence of COPD is double in rural (8.2%) compared to urban areas (4.7%). Rurality is associated with worse COPD outcomes, such as more severe dyspnea, poorer self- rated health, lower health-related quality of life (HRQL), and increased risk of acute exacerbations. Significant geographical disparities exist in treating and managing COPD in the United States. Less than 8% of rural patients have access to pulmonary rehabilitation, a critical treatment for COPD patients that improves all outcomes and decreases health care utilization. This project addresses an important SDOH problem: access to proper care. It will provide pulmonary rehabilitation that promotes physical activity and exercise, as well as customized education with personalized support through health coaching for patients with COPD in rural areas. Our prior NIH-funded research in the delivery of Home-based rehabilitation, in addition to the current literature, supports the scientific rationale and need for a clinical trial to test the proposed hypothesis. This application aims to test the uptake, effectiveness, and patient-caregiver-provider experience of home- based pulmonary rehabilitation with health coaching for COPD patients in rural communities. The proposed research that addresses access to care as the main social determinant of health will consider patient/community priorities, needs, and preferences through a personalized approach through health coaching. The program has been tested effective in two large NIH-funded randomized studies but not specifically tested in rural settings. The comprehensive qualitative assessment of the intervention will inform any necessary adaptation. The proposed intervention will address two aspects of social injustice in COPD: inadequate COPD care and lack of support (factors that make living with COPD more difficult than it should be, i.e., social isolation in rural areas). If the project aims are achieved, an increased pulmonary rehabilitation uptake and improved physical and emotional quality of life will advance the scientific knowledge, technical capability, and/or clinical practice of rural patients living with COPD. Our results may inform the remote care for other chronic conditions in rural patients (heart failure, hypertension, obesity, diabetes).