Nishi Shawn P E, Zhang Wei, Kuo Yong-Fang, Sharma Gulshan
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine (Drs Nishi and Sharma and Mr Zhang), and Sealy Center on Aging (Drs Kuo and Sharma), University of Texas Medical Branch-Galveston, Galveston.
J Cardiopulm Rehabil Prev. 2016 Sep-Oct;36(5):375-82. doi: 10.1097/HCR.0000000000000194.
To assess the trends in pulmonary rehabilitation (PR) utilization and factors associated with its use in older adults with chronic obstructive pulmonary disease (COPD).
We examined data for Medicare beneficiaries with COPD who received PR from January 1, 2003, to December 31, 2012. Persons with COPD were identified by (1) ≥2 outpatient visits >30 days apart within 1 year with an encounter diagnosis of COPD or (2) an acute care hospitalization with COPD as the primary diagnosis or a primary diagnosis of acute respiratory failure with a secondary discharge diagnosis of COPD. PR utilization was the study outcome identified by health care common procedure coding system codes G0237, G0238, G0239, and G0424 (after year 2010) or current procedural terminology codes (97001, 97003, 97110, 97116, 97124, 97139, 97150, 97530, 97535, and 97537) in a calendar year.
Patients with COPD who received PR increased from 2.6% in 2003 to 3.7% in 2012 (P = .001). In a multivariable analysis, factors associated with receipt of PR were younger age, non-Hispanic white race, high socioeconomic status, multiple comorbidities (OR = 1.20; 95% CI = 1.13-1.27), and evaluation by a pulmonary physician (OR = 2.23; 95% CI = 2.13-2.33). Increased use of PR was attributed to prior users rather than new users of PR.
Utilization of PR during the study period increased only 1.1% in these Medicare beneficiaries with COPD and remained low.
评估慢性阻塞性肺疾病（COPD）老年患者肺康复（PR）的使用趋势及其相关因素。
我们研究了2003年1月1日至2012年12月31日期间接受PR的医疗保险受益的COPD患者的数据。COPD患者通过以下方式确定：（1）一年内间隔超过30天的≥2次门诊就诊，诊断为COPD；或（2）以COPD为主要诊断的急性护理住院，或以急性呼吸衰竭为主要诊断且COPD为次要出院诊断。PR的使用情况是通过医疗保健通用程序编码系统代码G0237、G0238、G0239和G0424（2010年后）或当年的现行程序术语代码（97001、97003、97110、97116、97124、97139、97150、97530、97535和97537）确定的研究结果。
接受PR的COPD患者从2003年的2.6%增加到2012年的3.7%（P = 0.001）。在多变量分析中，与接受PR相关的因素包括年龄较小、非西班牙裔白人种族、高社会经济地位、多种合并症（OR = 1.20；95% CI = 1.13 - 1.27）以及由肺科医生进行评估（OR = 2.23；95% CI = 2.13 - 2.33）。PR使用的增加归因于PR的既往使用者而非新使用者。
在这些医疗保险受益的COPD患者中，研究期间PR的使用率仅增加了1.1%，且仍然较低。
