Rehabilitation in Safety-net Settings for Patients With COPD

Chronic obstructive pulmonary disease (COPD), one of the leading causes of death in the US,
disproportionately affects low socioeconomic communities. While few interventions effectively
modify the course of COPD and improve outcomes, pulmonary rehabilitation is the one notable
exception. However, implementation of this resource-intensive program in real-life settings,
and in particular, for underserved communities, has proven to be challenging. Safety-net
centers that serve primarily under-insured populations lack financial resources to provide
pulmonary rehabilitation.

COPD Wellness, a 10-week low-intensity pulmonary rehabilitation program consisting of group
and home exercise, education, and social support, was developed to address this gap. This
intervention is targeted at patients with moderate to severe COPD (GOLD Class B-D) who
receive care through a safety-net health system. To be impactful, risk factors for low
adherence include both disease severity and socio-environmental factors, must be addressed.
As merely having a pulmonary rehabilitation program will not automatically lead to improved
outcomes.

As part of this study, an adherence strategy targeted at addressing unmet social needs to
improve health will also be implemented. A Health Advocates program that links social needs
screening with a tiered referral and linkage process to appropriate resources will be tested
to see if adherence to COPD Wellness (exercise intervention) improves by addressing competing
non-medical stressors.

Inclusion Criteria:

- Age: Are greater than or equal to 40 years

- Diagnosis: COPD Gold Stage Class B-D (symptomatic disease), COPD/Asthma overlap with
symptoms

- Language: English

- Care Center: ZSFG, Community Health Center clinics, Federally Qualified Health Centers

- Availability: Able to participate in a 10-week, weekly course at the weekly scheduled
time (can defer x 1)

Exclusion Criteria:

- Planning to move out of the area within the next year

- Eligible for and desire to go to full intensity pulmonary rehabilitation. Participant
has Medicare Part A and B OR have San Francisco Health Plan. For those that met these
criteria, we will assist with referral to program

- Resides in any kind of long-term care facilities that is NOT Laguna Honda or the
Mental Health Rehabilitation Facility

- Has a diagnosis of interstitial lung disease, pulmonary fibrosis, or cystic fibrosis

- Active, chronic lung infection, such as tuberculosis

- A history of a pulmonary embolism in the year (12 months) prior to recruitment

- History of a myocardial infarction in the year (12 months) prior to recruitment

- In the 12 weeks prior to recruitment, has had history of unstable heart disease
(including valve disease), heart failure, or uncontrolled irregular heart beat

Potential participants who have had the following will be re-assess for eligibility 6 weeks
after the initial assessment:

- A pulmonary exacerbation or worsening of COPD/Asthma symptoms in the past 6 weeks

- History of an upper respiratory infection in the past 6 weeks

- History of an eye, chest, or abdominal surgery within the past 6 weeks