Project Summary/Abstract Acute exacerbations of chronic obstructive pulmonary disease (COPD) result in significant morbidity and healthcare costs, especially severe exacerbations that require hospitalization. Traditional bronchodilators and anti- inflammatory medications, as well as programs to monitor and treat symptoms, have a modest effect on reducing hospital admissions. Readmission rates remain unacceptably high, so alternative approaches are needed. In this regard, pulmonary rehabilitation (PR) is remarkably effective, and is associated with an 80% reduction in admission rates. Successful completion of PR is also associated with substantial improvements in quality of life, dyspnea, as well as exercise tolerance. Despite these benefits, recent studies have highlighted very poor referral rates for PR overall and as low as 1.9% post-hospitalization, and non-completion rates as high as 60%. The poor adaptation of PR in the community is due to a combination of barriers in availability and accessibility, as well as attrition. The number of PR centers in the United States is inadequate, and these centers are mostly distributed in urban areas. In addition, multiple socioeconomic and medical barriers hinder access to PR, and contribute to high drop-out rates. New strategies are needed to reduce hospital readmission in COPD, and to increase the delivery of PR to underserved urban as well as rural areas in the community. Given the scarcities in existing resources, conventional models of care delivery are being challenged, and attempts are being made to find alternative, cost-effective ways of delivering healthcare to a larger number of eligible patients. To overcome the socioeconomic and physical barriers to PR, we hypothesize that a video telehealth intervention that will deliver PR to the patient's home, regardless of geographic location, will reduce hospital readmissions in COPD, and reduce respiratory morbidity. To test our hypothesis we propose a prospective randomized controlled phase 3 multicenter clinical trial comparing a real-time video telehealth PR intervention plus standard of care versus standard of care alone, with the following Specific Aims: (1) To determine if a video telehealth PR intervention reduces 30-day all-cause readmissions in patients hospitalized for acute exacerbation of COPD, (2) To evaluate the effects of the video telehealth PR intervention on dyspnea and respiratory quality of life in COPD post hospital discharge, and (3) To evaluate the cost-effectiveness of the telehealth intervention. Accomplishment of the aims of this study will result in a significant reduction in COPD readmission rates, and a paradigm shift in the way PR is delivered to patients with COPD, especially those that reside in remote and rural areas with limited access to pulmonary rehabilitation.

PROJECT NARRATIVE Twenty percent of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) are readmitted within 30 days of discharge. Pulmonary rehabilitation is associated with a reduction in hospitalization in patients with COPD, but significant barriers in availability and access limit its use. We propose a multicenter randomized controlled trial that will test whether a video telehealth pulmonary rehabilitation intervention that overcomes these barriers will reduce hospital readmissions, improve quality of life, and be cost-effective.