Fahy Bonnie F
Department of Pulmonary Rehabilitation, St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Respir Care. 2004 Jan;49(1):28-36; discussion 36-8.
Pulmonary rehabilitation (PR) is the standard of care for patients suffering chronic obstructive pulmonary disease (COPD). This report describes and defines PR and reviews the evidence regarding the efficacy of PR. COPD management guidelines that include PR have been published by the European Respiratory Society, the American Thoracic Society, and the British Thoracic Society, and those guidelines were supported by evidence-based guidelines published jointly by the American College of Chest Physicians and the American Association of Cardiovascular and Pulmonary Rehabilitation. The Global Initiative for Chronic Obstructive Lung Disease, which is also evidence-based, included the recommendation for referral to PR. Despite those recommendations, the availability of comprehensive PR programs (defined as being compliant with national practice standards) is limited. In the United States the lack of a national policy for PR reimbursement has led to differences in compensation among insurance providers, based on differences in the Local Medical Review Policies established by the "fiscal intermediaries." Since 1998 the American Association for Respiratory Care, the American College of Chest Physicians, the American Thoracic Society, and the National Association for Medical Direction of Respiratory Care have jointly lobbied for clear, consistent guidelines from the United States Health Care Financing Administration (HCFA, which was recently renamed the Centers for Medicare and Medicaid Services [CMS]). In 2002 new Medicare/Medicaid billing codes ("G codes") became available for billing PR procedures, but unfortunately the instructions for the use of those codes differ among the Local Medical Review Policies. There has been little success in the effort to establish a national coverage policy for PR. The respiratory therapist holds a unique role in PR. In the respiratory therapist's training curriculum PR is specifically addressed, making the respiratory therapist an asset to the multidisciplinary PR team. With their many clinical opportunities for making contact with COPD patients and physicians, respiratory therapists can be effective advocates for PR.
肺康复（PR）是慢性阻塞性肺疾病（COPD）患者的标准治疗方法。本报告描述并定义了肺康复，并回顾了有关肺康复疗效的证据。欧洲呼吸学会、美国胸科学会和英国胸科学会已发布了包含肺康复的COPD管理指南，这些指南得到了美国胸科医师学会和美国心血管与肺康复协会联合发布的循证指南的支持。同样基于循证的慢性阻塞性肺疾病全球倡议也包括了推荐转诊至肺康复的内容。尽管有这些推荐，但全面的肺康复项目（定义为符合国家实践标准）的可及性有限。在美国，缺乏关于肺康复报销的国家政策导致了保险提供商之间在补偿方面的差异，这是基于“财务中介机构”制定的地方医疗审核政策的差异。自1998年以来，美国呼吸护理协会、美国胸科医师学会、美国胸科学会和国家呼吸护理医学指导协会联合游说美国医疗保健财务管理局（HCFA，最近更名为医疗保险和医疗补助服务中心[CMS]）制定清晰、一致的指南。2002年，新的医疗保险/医疗补助计费代码（“G代码”）可用于肺康复程序计费，但不幸的是，这些代码的使用说明在地方医疗审核政策中各不相同。在努力制定肺康复的全国覆盖政策方面几乎没有取得成功。呼吸治疗师在肺康复中发挥着独特的作用。在呼吸治疗师的培训课程中专门涉及了肺康复内容，这使呼吸治疗师成为多学科肺康复团队的一项资产。凭借与COPD患者和医生接触的众多临床机会，呼吸治疗师可以成为肺康复的有效倡导者。
