Choi Joon Young, Kim Ki Uk, Kim Deog Kyeom, Kim Yu-Il, Kim Tae-Hyung, Lee Won-Yeon, Park Seong Ju, Park Yong Bum, Song Jin Woo, Shin Kyeong-Cheol, Um Soo-Jung, Yoo Kwang Ha, Yoon Hyoung Kyu, Lee Chang Youl, Lee Ho Sung, Leem Ah Young, Choi Won-Il, Lim Seong Yong, Rhee Chin Kook
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Seo-gu, Busan.
Chest. 2024 Feb;165(2):313-322. doi: 10.1016/j.chest.2023.09.026. Epub 2023 Oct 6.
Poor uptake to pulmonary rehabilitation (PR) is still challenging around the world. There have been few nationwide studies investigating whether PR impacts patient outcomes in COPD. We investigated the change of annual PR implementation rate, medical costs, and COPD outcomes including exacerbation rates and mortality between 2015 and 2019.
Does PR implementation improve outcomes in patients with COPD in terms of direct cost, exacerbation, and mortality?
Data of patients with COPD extracted from a large Korean Health Insurance Review and Assessment service database (2015-2019) were analyzed to determine the trends of annual PR implementation rate and direct medical costs of PR. Comparison of COPD exacerbation rates between pre-PR and post-PR, and the time to first exacerbation and mortality rate according to PR implementation, were also assessed.
Among all patients with COPD in South Korea, only 1.43% received PR. However, the annual PR implementation rate gradually increased from 0.03% to 1.4% during 4 years, especially after health insurance coverage commencement. The direct medical cost was significantly higher in the PR group than the non-PR group, but the costs in these groups showed decreasing and increasing trends, respectively. Both the incidence rate and frequency of moderate-to-severe and severe exacerbations were lower during the post-PR period compared with the pre-PR period. The time to the first moderate-to-severe and severe exacerbations was longer in the PR group than the non-PR group. Finally, PR implementation was associated with a significant decrease in mortality.
We concluded that health insurance coverage increases PR implementation rates. Moreover, PR contributes toward improving outcomes including reducing exacerbation and mortality in patients with COPD. However, despite the well-established benefits of PR, its implementation rate remains suboptimal.
在全球范围内，肺康复（PR）的接受率较低，这仍然是一个具有挑战性的问题。很少有全国性研究调查PR是否会影响慢性阻塞性肺疾病（COPD）患者的预后。我们调查了2015年至2019年期间PR的年度实施率、医疗费用以及COPD的预后变化，包括急性加重率和死亡率。
PR的实施在直接成本、急性加重和死亡率方面是否能改善COPD患者的预后？
从韩国一个大型健康保险审查和评估服务数据库（2015 - 2019年）中提取COPD患者的数据，以确定PR的年度实施率趋势和PR的直接医疗费用。还评估了PR前和PR后COPD急性加重率的比较，以及根据PR实施情况首次急性加重的时间和死亡率。
在韩国所有COPD患者中，只有1.43%接受了PR。然而，在4年期间，PR的年度实施率从0.03%逐渐增加到1.4%，尤其是在医疗保险覆盖开始之后。PR组的直接医疗费用显著高于非PR组，但这些组的费用分别呈现下降和上升趋势。与PR前相比，PR后中重度和重度急性加重的发生率和频率均较低。PR组首次中重度和重度急性加重的时间比非PR组长。最后，PR的实施与死亡率显著降低相关。
我们得出结论，医疗保险覆盖提高了PR的实施率。此外，PR有助于改善预后，包括降低COPD患者的急性加重和死亡率。然而，尽管PR有公认的益处，但其实施率仍然不理想。
