Effectiveness and Feasibility of Post-Exacerbation Pulmonary Rehabilitation (PEPR) in a Real-World Clinical Setting: A Quality Improvement Project

Background
The implementation of Post-Exacerbation Pulmonary Rehabilitation (PEPR) in clinical practice has some challenges.

Aim
The aim of this project was to evaluate the feasibility and effectiveness of PEPR in practice.

Material and methods
Data were collected prospectively from 112 patients referred to PEPR. Healthcare (HC) utilization was measured by 30- and 90-day readmissions (30R&90R) and emergency departments visits (30ED&90ED), and compared between PEPR completers, drop-outs, and decliners (Chi-squared test). Incremental cost effectiveness (ICER) was calculated. The Incremental Shuttle Walk Test (ISWT), the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), the Breathing Problem Questionnaire (BPQ), and the Hospital Anxiety and Depression Score (HADS) were all assessed pre- and post-PEPR.

Results
Compared to PEPR completers (n = 38), PEPR decliners (n = 59) and drop-out patients (n = 15) had more 30&90ED attendances (8% vs. 24% and 47%; χ2 = 4.31, p = 0.04 and χ2 = 9.60, p = 0.002, respectively), 30R (5% vs. 20% and 27%; χ2 = 4.67, p = 0.03 and χ2 = 4.44, p = 0.04, respectively), and 90R (3% vs. 24% and 40%; χ2 = 7.93, p = 0.005 and χ2 = 12.39, p < 0.001, respectively). The ICER was £7,248 (€8,394) in favor of the PEPR-completer group. There were significant improvements of mean difference in all assessment tests for patients who completed PEPR (95% CI), with the exception of their HADS score. In the ISWT, patients had a mean distance of 50.3 m (29.7 m pre-PEPR and 70.9 m post-PEPR; p < 0.001); patients had a mean score of -3.6 on the BPQ (-1.7 pre-PEPR, -5.4 post-PEPR; p = 0.001), and a mean CAT score of -4.3 (-1.9 pre-PEPR, -6.7 post-PEPR; p = 0.002).

Conclusion
PEPR is feasible and cost-effective. Several factors should be considered for HC quality and effectiveness improvement.