Disparities in Geographic Access to Hospital Outpatient Pulmonary Rehabilitation Programs in the United States

Ira S Moscovice, Michelle M. Casey, Zhengtian Wu

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: For individuals with COPD, pulmonary rehabilitation (PR) improves outcomes in terms of exercise capacity, severity of dyspnea, and health-related quality of life. However, many US patients with COPD do not use PR services. There has been limited research on geographic access to needed health-care services for individuals who live in rural communities in the United States. This study: (1) examines the geographic distribution of hospital-based outpatient PR programs in the US; and (2) compares the organizational characteristics of hospitals that offer PR programs and those that do not. Methods: A multistep process supported the determination of whether a hospital provided PR services and included: program directory data from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) website and websites for AACVPR state affiliates and other COPD-relevant organizations; searches of hospital websites; e-mails with state contacts and other state organizations; and phone calls with hospital staff and state contacts. The study population included all Medicare-certified short-term acute care general medical and surgical hospitals. Data were collected and analyzed from January to November 2018. Medicare Provider of Service and American Hospital association data were used to compare the characteristics of hospitals with and without PR programs, using descriptive and bivariate statistics. Results: 1,776 US counties do not have a hospital outpatient PR program located in a short-term acute care general medical or surgical hospital in the county, including 697 counties that do not have a hospital. The availability of a hospital outpatient PR program varies significantly by county type, hospital type and Census region. Hospitals located in a noncore county, designated as a Critical Access Hospital, or located in the South and the West were less likely to have an outpatient PR program. Conclusions: Significant geographic disparities exist in access to hospital outpatient PR. Potential strategies for addressing these disparities include: increasing clinician and patient awareness of the potential benefits of PR; offering staff training and incentives to supervise and provide PR services; improving Medicare reimbursement rates for PR services; replicating PR programs that have success serving rural areas; expanding cardiac rehabilitation programs to include PR; and assessing the use of telehealth technologies to provide PR in isolated areas.

Original languageEnglish (US)
Pages (from-to)308-315
Number of pages8
JournalCHEST
Volume156
Issue number2
DOIs
StatePublished - Aug 2019

Bibliographical note

Funding Information:
FUNDING/SUPPORT: This study was supported by the Federal Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services under PHS [Grant 5U1CRH03717]. FUNDING/SUPPORT: This study was supported by the Federal Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services under PHS [Grant 5U1CRH03717]. Author contributions: I. S. M. had full access to all the data in the study and takes responsibility for the content of the manuscript, the integrity of the data, and the accuracy of the analysis. I. S. M. contributed to the study concept and design, acquisition, analysis, and interpretation of data; critical revisions of the manuscript for important intellectual content; and study supervision. M. M. C. contributed to the study concept and design; acquisition, analysis, and interpretation of data; drafting of the manuscript; and study supervision. Z. W. contributed to the study concept and design; acquisition, analysis, and interpretation of data; and critical revisions of the manuscript for important intellectual content. Financial/nonfinancial disclosures: None declared. Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Other contributions: We thank the assistance provided by the COPD Foundation State Captains, the American Association of Cardiovascular and Pulmonary Rehabilitation state affiliate representatives, and other state-level health-care organizations in identifying pulmonary rehabilitation programs in their states. FUNDING/SUPPORT: This study was supported by the Federal Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services under PHS [Grant 5U1CRH03717].

Keywords

  • COPD
  • access to care
  • hospitals
  • pulmonary rehabilitation
  • rural populations

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