Increasing Pulmonary Rehabilitation Referrals in COPD Patients: A Quality Improvement Initiative

Abstract

Rationale: Pulmonary Rehabilitation (PR) for Chronic Obstructive Pulmonary Disease (COPD) patients has been demonstrated to improve quality of life, emotional function, exercise capacity and decrease dyspnea and health care utilization yet is very underutlized in our COPD population. Methods: The University of Michigan initiated a quality improvement project to 1) improve COPD patient referrals to the outpatient PR program and 2) understand the delay in patients getting into the PR program. We performed a 12-month review of our quality metrics using the Hospital Quality Dashboard to determine the number of COPD patients eligible for PR. A 6-month chart review was completed to understand the reasons for PR not being initiated within a 60-day time frame. Patients were deemed eligible if they were 18 years and older, had at least one encounter in an inpatient or emergency room with a diagnosis of COPD within the past 3 years. Results: The PR referral rate for the institution is 17%. Only 47% of those referred to the PR program had a visit within 6o days of the referral. Reasons for this include: other patient care issues (25%), patient declined/feeling better (21%), transportation issues (11%), currently smoking (11%), unable to contact patient (11%), no pulmonary function testing (11%), referral placed incorrectly (4%), patient currently enrolled in a research study (3%) and the patient requesting to speak with a physician before starting PR (3%). Conclusions: We have an understanding on where to focus our next steps to assist in getting patients into PR in a timely manner. We provided a conference for providers and placed flyers in clinic areas to increase awareness of importance of PR.