Implementation and maintenance of an enhanced pulmonary rehabilitation program in a single centre: An implementation study.

ABSTRACT

BACKGROUND: Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre. METHODS: Pre-post implementation study consisted of two evaluation periods immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS: Reach 70-75% of referred patients agreed to a PR program (n = 26). Effectiveness Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. Adoption All healthcare professionals (HCPs) involved in PR (n = 8) participated. Implementation Fidelity for the group education sessions ranged from 76 to 95% (first evaluation) and from 82 to 88% (second evaluation). Maintenance The program was sustained over 18 months with minor changes. Patients and HCPs were highly satisfied with the program. CONCLUSIONS: The enhanced PR program was accepted by patients and HCPs and was implemented and maintained at a single expert center with good implementation fidelity.