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Effectiveness and Economic Evaluation of Hospital-Outreach Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease

Authors Zhang A, Wang L, Long L, Yan J, Liu C, Zhu S, Wang X

Received 18 February 2020

Accepted for publication 27 March 2020

Published 15 May 2020 Volume 2020:15 Pages 1071—1083


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Prof. Dr. Chunxue Bai

Aidi Zhang,1 Lianhong Wang,2 Lu Long,1 Jin Yan,1,3 Chun Liu,4 Sucui Zhu,1 Xiaowan Wang5

1Nursing Department, Third Xiangya Hospital of Central South University, Changsha 410013, People’s Republic of China; 2The First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, People’s Republic of China; 3Xiang Ya Nursing School of Central South University, Changsha 410013, People’s Republic of China; 4Respiratory Department, Third Xiangya Hospital of Central South University, Changsha 410013, People’s Republic of China; 5Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People’s Republic of China

Correspondence: Jin Yan Email

Objective: Hospital-outreach pulmonary rehabilitation (PR) can improve health status and reduce health-care utilization by patients with chronic obstructive pulmonary disease (COPD). However, its long-term effects and costs versus benefits are still not clear. This study was conducted to develop, deliver, and evaluate the effects and monetary savings of a hospital-outreach PR program for patients with COPD.
Methods: A randomized controlled trial was conducted. Patients with COPD (n=208) were randomly assigned to the hospital-outreach PR program (treatment) or treatment as usual (control). The treatment group received a 3-month intensive intervention, including supervised physical exercise, smoking cessation, self-management education, and psychosocial support, followed by long-term access to a nurse through telephone follow-up and home visits up to 24 months. The control group received routine care, including discharge education and a self-management education brochure. Main outcomes were collected at 3, 6, 12, and 24 -months postrandomization. Primary outcomes included health-care utilization (ie, readmission rates, times, and days, and emergency department visits) and medical costs. Secondary outcomes included lung function (ie, FEV1, FEV1% predicted, FVC), dyspnea (mMCR), exercise capacity (6MWD), impact on quality of life (CAT), and self-management (CSMS).
Results: At the end of 24 months, 85 (81.7%) in the treatment group and 89 (85.6%) in the control group had completed the whole program. Compared with the control group, patients in the treatment group had lower readmission rates, times, and days at 6 and 12 months and during 12– 24 months. Regarding costs during the 2 years, the program achieved CN¥ 3,655.94 medical  savings per patient per year, and every ¥ 1 spent on the program led to ¥ 3.29 insavings. Patients in the treatment group achieved improvements in FEV1, FEV1% predicted, exercise capacity, and self-management. It also achieved relief of dyspnea symptoms and improvement in COPD’s impact on quality of life.
Conclusion: The hospital-outreach PR program for patients with COPD achieved reductions in health-care utilization, monetary savings, and improvements in patient health outcomes. The effects of the program were sustained for at least 2 years.
Trial Registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-TRC-14005108).

Keywords: chronic obstructive pulmonary disease, savings, effects, hospital-outreach intervention, pulmonary rehabilitation

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