• Kerry A Spitzer, Mihaela S Stefan, Aruna Priya, Quinn R Pack, Penelope S Pekow, Tara Lagu, Kathy M Mazor, Victor M Pinto-Plata, Richard L ZuWallack, and Peter K Lindenauer.
• Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield, MA. Electronic address: Kerry.Spitzer@baystatehealth.org.
• Chest. 2020 May 1; 157 (5): 1130-1137.

BackgroundGuidelines recommend pulmonary rehabilitation (PR) after hospitalization for an exacerbation of COPD, but few patients enroll in PR. We explored whether density of PR programs explained regional variation and racial disparities in receipt of PR.MethodsWe used Centers for Medicare & Medicaid Services data from 223,832 Medicare beneficiaries hospitalized for COPD during 2012 who were eligible for PR postdischarge. We used Hospital-Referral Regions (HRR) as the unit of analysis. For each HRR, we calculated the density of PR programs as a measure of program access and estimated risk-standardized rates of PR within 6 months of discharge overall, and for non-Hispanic, white, and black beneficiaries. We used linear regression to examine the relationship between access to PR and HRR PR rates. We tested for racial disparity in PR rates among non-Hispanic white and black beneficiaries living in the same HRRs.ResultsAcross 306 HRRs, the median number of PR programs per 1,000 Medicare beneficiaries was 0.06 (interquartile range [IQR], 0.04-0.10). Risk-standardized rates of PR ranged from 0.53% to 6.67% (median, 1.93%). Density of PR programs was positively associated with PR rates overall and among non-Hispanic white beneficiaries (P < .001), but this relationship was not observed among black beneficiaries. Rates were higher among non-Hispanic white beneficiaries (median, 2.08%; IQR, 1.54%-2.87%) compared with black beneficiaries (median, 1.19%; IQR, 1.15%-1.20%).ConclusionsGreater PR program density was associated with higher rates of PR for non-Hispanic white but not black beneficiaries. Further research is needed to identify reasons for this discrepancy and strategies to increase receipt of PR for black patients.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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