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Participation in Pulmonary Rehabilitation by Veterans Health Administration and Medicare Beneficiaries After Hospitalization for Chronic Obstructive Pulmonary Disease

Vercammen-Grandjean, Christopher, MD, MS, MPH; Schopfer, David W., MD, MAS; Zhang, Ning, MS; Whooley, Mary A., MD

Journal of Cardiopulmonary Rehabilitation and Prevention: November 2018 - Volume 38 - Issue 6 - p 406–410
doi: 10.1097/HCR.0000000000000357
Pulmonary Rehabilitation

Background: Hospitalization with acute exacerbation of chronic obstructive pulmonary disease (COPD) is common and costly to the health care system. Pulmonary rehabilitation (PR) can improve symptom burden and morbidity associated with COPD. The use of PR among Medicare beneficiaries is poor, and the use by Veterans Health Administration (VHA) beneficiaries is unknown. We sought to determine whether participation in PR was similarly poor among eligible veterans compared with Medicare beneficiaries.

Methods: We performed a retrospective study using national VHA and Medicare data to determine the proportion of eligible patients who participated in PR after hospitalization for an acute exacerbation of COPD between January 2007 and December 2011. We also evaluated patient characteristics including demographic factors and comorbid medical history associated with participation.

Results: Over the 5-year study period, 485 (1.5%) of 32 856 VHA and 3199 (2.0%) of 158 137 Medicare beneficiaries hospitalized for COPD attended at least 1 session of PR. Among both VHA and Medicare beneficiaries, participation was higher in those who had had comorbid pneumonia or pulmonary hypertension and was lower in older patients. Although participation increased in both groups over time, it remained exceedingly low overall.

Conclusion: Pulmonary rehabilitation is significantly underused in both the VHA and Medicare populations. Although comorbid pulmonary disease is associated with higher use, the proportion of eligible patients who participate remains extremely low.

Use of pulmonary rehabilitation (PR) programs in patients after chronic obstructive pulmonary disease exacerbation is recommended, but the use among veterans is unknown. We determined that PR is underused among both Veterans Health Administration and Medicare beneficiaries, while the increase in use of PR has been marginal over time.

University of California San Francisco (Drs Vercammen-Grandjean, Schopfer, and Whooley and Ms Zhang); and San Francisco VA Health Care System, San Francisco, California (Drs Schopfer and Whooley).

Correspondence: David W. Schopfer, MD, MAS, San Francisco VA Health Care System, 4150 Clement St (111A1), San Francisco, CA 94121 (

The authors declare no conflicts of interest.

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