Background PEPR has been shown to increase exercise tolerance, improve QoL and cut the cost of healthcare through reducing 30 day readmissions and A&E attendances (NICE 2010). Further research into the impact of PEPR on QoL and healthcare utilisation has been called for (NICE 2010). The feasibility of PEPR in practice has yet to be established (Jones et al 2013, Thorax). We secured funding to pilot PEPR in our local DGH population. Here, we present the initial five months data.
Aims and objectives This study aimed to investigate the impact of PEPR on exercise tolerance, QoL and health care utilisation in a local DGH population.
Methods Data were collected prospectively from successive patients referred for PEPR between December 2012 and May 2014. Outcome measures consisted of ISWT and QoL (CAT). Healthcare utilisation was measured through 30 and 90 day readmission and A&E attendance rates. Descriptive statistics and significance values were calculated in SPSS (version 22) using paired t-test and Chi2.
Results 64 patients were referred to PEPR. 53% (n = 34) decline to attend, 15% (n = 10) failed to complete the programme. Subsequently 31% (n = 20) patients completed PEPR which is comparable to standard PR. Exercise tolerance was significantly improved (difference between the means 46 m 95% CI +/-33 m p = 0.009). QoL was significantly improved (difference between the means 5.4 95% CI +/-3.1 p = 0.002). Table 1 demonstrates the impact of PEPR on healthcare utilisation. Both 30 and 90 day readmissions were significantly reduced. 90 day A&E attendances were significantly reduced. Average LoS following readmission in the group who declined PEPR was 11 days compared to an average LoS following readmission in PEPR group of 1 day. Considering the savings associated with bed days alone and staffing expenses the cost benefit of PEPR was £21309 pa.
Conclusions Results suggest PEPR in a DGH population has a significant impact on QoL and exercise tolerance with reductions in healthcare utilisation and associated cost benefits.