CHALLENGES TO IMPLEMENTING A HOME-BASED PULMONARY REHABILITATION PROGRAM FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS FOLLOWING DISCHARGE FROM AN ACADEMIC, COMMUNITY-BASED HOSPITAL

Abstract

TYPE: Abstract Publication TOPIC: Pulmonary Rehabilitation PURPOSE: Develop, implement and test a home-based PR program for the COPD patients discharged from the hospital following an Acute exacerbation(AeCOPD). METHODS: We developed a home-based program consisting of: 1) COPD Nurse review of patients hospitalized with COPD; 2) Nurse visits to potentially eligible patients; 3) A home-based PR program for home-bound patients, utilizing our hospital’s home care agency; 4) Intervention was centered on an exercise video intervention created by our staff, and implemented by homecare professionals, including a team of nurses, physical therapists, in communication with our COPD Nurse. Eligibility criteria included: a) diagnosis of AeCOPD; b) Discharge to home; c) Homebound status; d) Compatible insurance; e) Absence of co-morbid conditions that would preclude safe or effective PR.This intervention was at no or minimal extra cost. RESULTS: 248 patients hospitalized with a diagnosis of AeCOPD were screened during hospitalization. Of these, 228 (92%) were deemed not eligible for our home-based intervention. Non-eligible status included: 1) Non-coverage by the patient’s insurance (36%); 2) Co-morbid conditions that would preclude timely post-discharge pulmonary rehabilitation (25%); 3) Incorrect diagnosis of AeCOPD (17%); 4) Discharge disposition issues (not to home or not homebound) (16%); and 5) Psychological or substance abuse issues (6%). Of the 20 patients (8%) considered eligible, 9 refused, 1 gave a “maybe” answer, 8 accepted, and 2 did not give consent prior to discharge. CONCLUSIONS: Our novel home-based PR intervention, despite no significant additional cost to the patient, had extremely low uptake. CLINICAL IMPLICATIONS: Home-based PR programs albeit promising might be challenging to implement in clnical scenario. DISCLOSURE: No significant relationships. KEYWORD: Pulmonary Rehabilitation, Home Based, COPD