The pulmonary rehabilitation value chain
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After participating in pulmonary rehab, not only do patients have improved exercise capabilities and 6-minute walk scores, but [also] better quality-of-life scores.”
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
COPD Case Manager
UCalDavis
Pulmonary rehab is a common facet of many COPD care plans, and for good reason. Implementing and promoting pulmonary rehab can kick off a chain reaction of benefits that can positively affect your institution in several ways. The physical and mental benefits of pulmonary rehab combine to create a powerful influence on the patients’ overall outlook.
Pulmonary rehab
Physical benefits
Proven to improve lung function, making it easier for patients to breathe.1,2
Mental benefits
Shown to impact health perception, social function, and mental health.3
Improved quality of life
Patients with COPD can feel isolated and anxious – around 40% suffer from severe or clinical depression.4 Socializing in a group pulmonary rehab class improves their spirits and boosts their morale. “It’s not only the exercise and the education they receive on their disease, but it’s also that social aspect of pulmonary rehab where they feel like they’re going somewhere with patients – people just like them – so that’s improving the way they feel,” says Krystal Craddock, a COPD case manager.
Contributor
Krystal Craddock, BSRC, RRT-NPS, AEC
COPD Case Manager Department of Respiratory Care at UC Davis Medical Center
Insider case study:
How a Kaizen event works
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
The approach
When COPD patients at UC Davis head to pulmonary rehab, they’re encouraged to focus on more than just their lungs. The staff asks about their lifestyles, with a goal of helping them feel well enough to again be able to participate in the things they enjoy.
The result:
By setting goals and working toward them, Craddock finds that her patients are often able to get back to their previous lives in many regards.
We had one patient and her goal was to go bowling with her bowling team again,” Craddock says. “After pulmonary rehab, she sent a picture to her pulmonologist with her and her bowling team, because she was able to meet that goal. Individualized care with these goals in mind is really beneficial and improves these patients’ quality of life, and you can see it in each one of them.”
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
COPD Case Manager
UCalDavis
A higher quality of life leads to reduced ER visits and readmissions
Patients who have strengthened their lung function through pulmonary rehab and are well-educated on their conditions are less likely to experience an exacerbation or readmission.5,6 But on top of the basic direct benefits of pulmonary rehab, simply having somewhere to go and something to do can help COPD patients steer clear of the ER, Craddock believes, and drive down COPD readmissions. Pulmonary rehab provides a structured environment with expert staff on hand, so patients feel comfortable, safe, and reassured there. “You can see the difference in hospitals, in their patients and [in] their patient outcomes, when they have a pulmonary rehab program versus when they don’t,” Craddock says. “I hear it from them all the time: We don’t have a pulmonary rehab program and we have these patients who come in all the time. My thought is that if they had somewhere to go other than the hospital and the emergency room, and they can go to pulmonary rehab, it’s one more place for them to go and to reduce them having to come in and take up resources.” In addition, data actually shows that patient satisfaction and improved quality of life can keep COPD readmissions at bay.
Insider intel: The impact of quality of life on readmissions
Many researchers have found that higher overall patient satisfaction and better quality of life can help reduce readmissions.7,8 In one study, 266 COPD patients who’d been admitted for exacerbations were asked to fill out questionnaires, allowing researchers to assign quality-of-life scores based on their levels of distress and how well they were coping9. The result: Poorer quality-of-life scores were significantly associated with increased likelihood of readmission for COPD over the next 12 months.
The higher the score, the poorer the quality of life
51.4
the average QOL score of the patients who were not readmitted in the next 12 months9
56.2
the average QOL score of patients who went on to be readmitted or died in the 12 months following the questionnaire9
“Those with greater distress and poorer coping were more likely to be re-admitted,” the study found. “When QOL improves…consultations and hospital admissions decrease.”
Happier patients and fewer readmissions lead to a boost to your bottom line
Pulmonary rehab can boost your bottom line in more ways than one. First, by reducing ER visits and COPD readmissions, you reduce the pressure on your inpatient COPD care team – a group that’s often stretched far too thin. “COPD patients can be high utilizers of resources,” Craddock says. “But if there’s a pulmonary rehab program, it wouldn’t be such a burden on the hospital and the emergency room department and staff.” On top of the improved efficiency that can come from streamlining COPD-related workflow, pulmonary rehab can help your organization avoid costly readmission penalties. Additionally, not only are happier and healthier patients less likely to be readmitted9, they may also boost your institution’s reputation, setting the stage for improved future business and revenue. “You’re having happier patients and you’re having better survey scores that your patients give when they’re receiving care at your health system,” Craddock says. “And healthcare has changed over the past 10 years to where we’re looking at not only cost and reimbursement, but it’s also that reimbursement is based on patient satisfaction scores.”
Starting your own pulmonary rehab program
Getting a pulmonary rehab program off the ground can require a significant expenditure of time and resources, but it’s an investment that will pay off down the road, Craddock says. “In the long run, you’re helping reduce your readmission rates by offering another service for patients,” she explains. For help getting started, Craddock offers several suggestions:
Model other successful programs
One of the best ways to establish a strong pulmonary rehab program is to look to other successful programs for ideas and inspiration, Craddock says. Use your contacts in the field and in your network to gain real-world insight into what works and what doesn’t – and to learn from the mistakes that others might have made.
Tap into available resources
Craddock recommends relying on groups like the American Association of Cardiovascular and Pulmonary Rehabilitation and the American Association for Respiratory Care for invaluable tips and information. “Both associations have a great toolkit on how to get started and how to build a successful program,” she says.
Look to your patients for inspiration
The most fruitful information won’t come from an official organization or an existing pulmonary rehab program, Craddock says. It’s been in front of you all along, in the form of your patients. “Listen to your patients,” Craddock suggests. “I’ve said this a million times – you learn more from your patients than you do from anyone else. Finding out what the needs of your patients are in your area is important because all of us have different demographics and different socioeconomic needs.”
Insider insight: Considering patient interests when planning pulmonary rehab
Engaging patient populations
By taking the time to get to know the patient populations in your region, you’ll be able to more effectively tailor a pulmonary rehab program based on their needs and interests. For example, for Craddock’s patients at UC Davis, there’s nothing run-of-the-mill about pulmonary rehab. UC Davis offers fun and unique options like yoga classes and a pulmonary rehab choir – aptly named the Rockin’ Rehab-ers – to make rehab more interesting and engaging.
Pulmonary rehab classes
“We didn’t know at first whether or not it would be something that was accepted by the pulmonary rehab department as well as the patients, but they just welcomed it with open arms and they’re still going,” Craddock says. “They go and perform at Shriner’s Children’s Hospital, they performed at the VA, they get together – a group of people from all different backgrounds – and sing and perform. So, you can start a pulmonary rehab program with just exercise and education as the goal and then grow it into something where you’re starting yoga classes and you’re starting choirs and different things for your patients.”
Craddock urges healthcare organizations to look at pulmonary rehab as a hard-and-fast necessity, rather than a luxury that comes and goes based on an institution’s fluctuating budget. “We definitely need more pulmonary rehab programs, and physicians and health systems need to recognize this,” she says. “I’ve talked to a lot of people throughout the country at different conferences I’ve been to, and so many programs have either shut down or they just don’t have one because of the cost in the investment, but it’s something that our patients definitely need.” Not only will your patients benefit from the education and exercise they get through pulmonary rehab, but your institution will gain distinct clinical, operational, and financial benefits as well.
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