Participation in pulmonary rehabilitation after hospitalization for chronic obstructive pulmonary disease among medicare beneficiaries

Kerry A. Spitzer, Mihaela S. Stefan, Aruna Priya, Quinn R. Pack, Penelope S. Pekow, Tara Lagu, Victor M. Pinto-Plata, Richard L. ZuWallack, Peter K. Lindenauer*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


Rationale: Current guidelines recommend pulmonary rehabilitation (PR) after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, but little is known about its adoption or factors associated with participation. Objectives: To evaluate receipt of PR after a hospitalization for COPD exacerbation among Medicare beneficiaries and identify individual- and hospital-level predictors of PR receipt and adherence. Methods: We identified individuals hospitalized for COPD during 2012 and recorded receipt, timing, and number of PR visits. We used generalized estimating equation models to identify factors associated with initiation of PR within 6 months of discharge and examined factors associated with number of PR sessions completed. Results: Of 223,832 individuals hospitalized for COPD, 4,225 (1.9%) received PR within 6 months of their index hospitalization, and 6,111 (2.7%) did so within 12 months. Median time from discharge until first PR session was 95 days (interquartile range, 44–190 d), and median number of sessions completed was 16 (interquartile range, 6–25). The strongest factor associated with initiating PR within 6 months was prior home oxygen use (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.39–1.59). Individuals aged 75–84 years and those aged 85 years and older (respectively, OR, 0.70; 95% CI, 0.66–0.75; and OR, 0.25; 95% CI 0.22–0.28), those living over 10 miles from a PR facility (OR, 0.42; 95% CI, 0.39–0.46), and those with lower socioeconomic status (OR, 0.42; 95% CI, 0.38–0.46) were less likely to receive PR. Conclusions: Two years after Medicare began providing coverage for PR, participation rates after hospitalization were extremely low. This highlights the need for strategies to increase participation.

Original languageEnglish (US)
Pages (from-to)99-106
Number of pages8
JournalAnnals of the American Thoracic Society
Issue number1
StatePublished - Jan 2019


  • Chronic obstructive pulmonary disease
  • Hospitalization
  • Medicare
  • Rehabilitation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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