TriNetX Real-World Data to Enhance Evidence-Based Respiratory Therapy Practice

Background:

TriNetX provides access to EMR data from U.S. healthcare organizations (HCOs) that allows comparison of outcomes (hospital admission, lab data, and mortality). Pulmonary rehabilitation (PR) has been shown to improve quality of life, functional ability, and reduce hospitalization. Medicare reimburses for PR in patients with moderate to severe COPD and utilization has been estimated at 2-4% of those eligible. Reasons for underutilization are multifactorial. We aimed to compare outcomes (hospital visits and mortality) for patients with COPD who received or did not receive at least 24 sessions of PR.

Methods:

The TriNetX database was queried to select cohorts of patients with ICD-10 code for COPD diagnosis [ICD10CM:J44, ICD10CM:J44.1, or ICD10CM:J44.0]. Cohort 1 had COPD, but no PR. Cohort 2 had COPD and charges for at least 24 sessions of PR [CPT (94625, 94626, 1036835, or 1015099)] after the index event. Patients with neoplasms were excluded. The cohorts were propensity matched for age at index, sex, race/ethnicity, diseases of the respiratory system, diseases of the circulatory system, diseases of the blood, BMI, and do not resuscitate status. Cohorts were compared for outcomes of inpatient hospitalizations, mortality, acidosis and hypercapnia over a 3-year period.

Results:

Sixty-four HCOs in the TriNetX U.S. Collaborative were queried. Before propensity matching Cohort 1 had 984,326 patients and Cohort 2 had 38,931 patients. After propensity matching both cohorts had 38,287 patients. The mean age at index was 62.4 y and sex was equally distributed. The majority (%) were white, 17% were Black and 6% were Hispanic. The median number of hospitalizations for Cohort 1 was two (2) and seven (7) for Cohort 2.[RK1] Survival probability at 3 years was 82.1% for Cohort 1 and 73.4% for Cohort 2. In Cohort 1, 3.5% of patients were hypercapnic (PaCO₂ > 50 mm Hg) and 3.3% were acidotic (pH < 7.33. Cohort 2 had 28.9% and 22.6% who were hypercapnic and acidotic, respectively.

Conclusions:

In this collected sample of patients with COPD, only 3.8% participated in 24 sessions of PR. The patients who participated in PR were sicker and had greater risk for hospitalization and mortality. It could be inferred that without PR, hospitalization and mortality would have been even greater for Cohort 2. TriNetX provides the ability to evaluate therapy effectiveness and outcomes.

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Kaplan-Meier Survival Curve