Abstract
Introduction
This study was designed to examine the physiologic, quality of life (QOL), and resource utilization measures of chronic obstructive pulmonary disease (COPD) patients in our health maintenance organization (HMO) pulmonary rehabilitation program.
Methods
We studied 47 COPD patients, aged 54-88 years, who participated in a 7-week pulmonary rehabilitation program from March 1995 through 1996. Patients were selected to participate if they had a diagnosis of COPD (including emphysema, chronic bronchitis, bronchiectasis, and chronic asthma), were symptomatic with impairment in activities of daily living, were motivated to complete the program, had a forced expiratory volume in the first second (FEV1) of < 60% predicted, had the mental and physical capability to participate, and were medically stable. Patients with heart or neurological conditions were excluded from the study. Patients attended a 7-week core program. Baseline QOL indicators, measured by a survey tool, and 5 pathophysiologic indicators: metabolic equivalents (MET), pulse oximetry saturation (SpO2), resting heart rate (RHR), functional aerobic impairment (FAI), and walking distance were measured immediately before and after the 7-week program. Charge data for the 12 months preand postprogram were retrieved from the HMO's billing system for hospital visits for which the primary diagnosis was COPD. Following the program patients chose whether to attend the Lung Gym, an exercise maintenance program.
Results
For 6 of the 7 survey questions QOL improved significantly (p < 0.01). For the pathologic indicators: MET increased from 2.49 equivalents to 2.72 equivalents (p < 0.02); SpO2 increased from 86.7% to 89.9% (p < 0.01); RHR decreased from 89 to 84 beats/min (p < 0.05); FAI decreased from 59% to 56% (p<0.2) but remained in the marked impairment range; and walking distance was not significantly improved. Utilization costs postprogram decreased to $939/patient (p < 0.01) with the average outpatient charge decreasing from $82.41 preprogram to $63.33 postprogram. Both Lung Gym and Non-Lung Gym groups decreased postprogram charges (p < 0.01 Lung Gym; p < 0.05 Non-Lung Gym).
Conclusions
This study revealed significant utilization savings when comparing COPD charge data for the 12-month period before and after completing the 7-week core program. Enhanced quality of life and pathophysiologic improvement were demonstrated using patient perceptions and clinical testing before and after the program.
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