Characteristics of Virtual Pulmonary Rehabilitation Programs in the United States: Results from a National Electronic Survey.

Abstract

Rationale: Understanding virtual pulmonary rehabilitation (VPR) in the U.S. would inform clinicians and patients, guide healthcare systems to ensure quality and safety, and inform payers on reimbursement issues.

Objective: To characterize U.S. VPR programs.

Methods: A 40-question online survey was developed by the American Thoracic Society PR Reimbursement Working Group to assess delivery methods, program content, and outcome assessments. U.S. VPR programs were identified from the Livebetter database, the internet, and scientific publications. Veterans Affairs (VA) sites were identified from an email sent to medical service chiefs asking whether their site offered VPR. The survey was sent to 53 programs using SurveyMonkey. Responses were summarized as percentages of available data. The 2010 Rural-Urban Commuting Area Codes characterized rurality.

Results: Twenty-five sites currently and 5 previously offered VPR; 23 were offered by an outpatient hospital department (7 non-VA, 16 VA), 5 were commercial, 1 physician office-based, and 1 independent. Eighty-four percent (16/19) of VPR programs offered by outpatient hospital departments concomitantly provided in-person PR, while 25% (1/4) of commercial sites did. Delivery method was 'live' 2-way videoconferencing for 88% (22/25) of sites; 47% (7/15) VA sites was also telephone-based, and 60% (3/5) commercial entities also used pre-recorded videos or website/mobile applications. Ninety-two percent (23/25) of programs provided an exercise prescription and resistance training, and 96% (24/25) provided aerobic training. Nearly one-quarter of respondents did not describe exercise progression. Seventy-four percent (17/23) of all programs provided exercise equipment, with 54% (7/13) VA programs using pedometers. Thirty-five percent (6/17) of outpatient hospital department sites conducted outcome assessments in-person only, 12% (2/17) conducted them virtually only, and 53% (9/17) provided both options, while 100% (5/5) commercial programs did so virtually. Six-minute walk test was the most common measure of exercise performance, used by 76% (13/17) outpatient hospital department sites and 20% (1/5) commercial programs. All VPR addresses were categorized as metropolitan or micropolitan; none were small town or rural.

Conclusions: VPR in the U.S. is heterogeneous. Although most delivered the broad components of PR, there is lack of in-person assessments, in-person standardized exercise testing, and plans for exercise progression, most notably by commercial programs.