Increasing Adherence to Pulmonary Rehabilitation after COPD-related Hospitalizations

PROJECT ABSTRACT / SUMMARY 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.