Improving Access to Pulmonary Rehabilitation for Hispanic and Black Patients with COPD Through Telehealth (TelePR)

The Telehealth-delivered Pulmonary Rehabilitation (TelePR) program was created to improve access to pulmonary rehabilitation (PR) for underserved Hispanic and Black patients with chronic obstructive pulmonary disease (COPD), particularly those recently hospitalized for COPD exacerbations. PR is effective, yet less than 1.5% of people but remains substantially underutilized because of limited access, low referral rates, transportation barriers, financial strain, insurance limitations, and debilitating respiratory symptoms. As a result, many patients with high disease burden and elevated risk of readmission are unable to participate in standard in-person PR (SPR).

This program was designed as a randomized controlled trial and supported by the Patient-Centered Outcomes Research Institute (PCORI) to compare program completion and fatigue outcomes among patients receiving TelePR vs. PR. TelePR was delivered through 16 sessions over 8 weeks, providing exercise training, symptom management education, and social support through remote/virtual sessions. Patients received home-based equipment, including a stationary exercise bike, stretch bands, weights, vital sign monitors, and a tablet with a WiFi card to facilitate participation. A bilingual respiratory therapist led the sessions, while a social worker assisted patients with insurance navigation, transportation coordination, scheduling, and other social needs. The program was conducted primarily in patients' homes. However, community centers were used when home spaces, safety, or internet access was limited. Patients were followed for one year to assess outcomes.

The TelePR intervention was built on strong evidence that PR reduces hospital utilization and improves quality of life. Internal hospital data highlighted high readmission rates and low PR participation among Hispanic and Black patients. The program was evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

Several outcomes were measured to assess the program’s impact. Hospitalizations and emergency department visits were tracked to evaluate changes in healthcare utilization. Mortality and symptom burden, including fatigue, were measured to understand the intervention’s effect on clinical outcomes and overall well-being. Additionally, COPD knowledge, physical endurance, social isolation, and program participation were assessed to evaluate improvements in patients’ self-management capacity, functional status, and engagement with care.

A Community Advisory Board, including Hispanic and African American patients, clinicians, a cardiologist, a population health physician, and community members, guided program planning and implementation. All materials were translated and reviewed for cultural and linguistic accuracy. Planning occurred over one year prior to enrollment.

• TelePR participants showed greater improvement in fatigue and exercise capacity compared with those in SPR. This may have been related to improved accessibility and more consistent participation in the home-based format.
• TelePR reduced social isolation and increased peer support, as virtual group sessions created regular opportunities for connection, shared experiences, and mutual encouragement among participants.
• The use of bilingual staff and culturally aligned materials improved patient comfort, understanding, and engagement by reducing language barriers and fostering trust and cultural relevance in care delivery.
• Quality of life improved during the 8-week program although some gains were not sustained at 12 months. Quality of life was measured using patient-reported outcomes, including physical functioning, symptom burden (such as fatigue and shortness of breath), emotional well-being, and ability to carry out daily activities.
• The decline over time likely reflects the loss of structured support following program completion, including supervised exercise, ongoing education, and regular social interaction, which made it more challenging for participants to sustain initial gains independently.

• Staff required: Bilingual respiratory therapist and social worker, pulmonologist, research coordinators, IT support, and a study manager
• Training & Expertise: COPD exercise protocols, telehealth technology, patient safety monitoring, and insurance/social service navigation
• Resources Required: Home delivery of equipment, technology support, and care coordination
• Barriers Encountered: Limited technology/internet access, housing constraints, medical clearance, insurance and copayment gaps, transportation, and limited phone access

TelePR shows that pulmonary rehabilitation can be delivered safely and effectively through telehealth for underserved patients. Other health systems could adapt key parts of the program, including telehealth visits, bilingual staff, social work support, community partnerships, flexible scheduling, and remote delivery of services.

However, expanding this model depends on staffing, technology access, and payment support. Challenges include limited insurance reimbursement for TelePR, shortages of respiratory therapists, technology barriers in low-income communities, managing patients with complex health needs, and long waitlists. Equipment may require additional funding, or partnership with local facilities such as community centers. Health systems would need to review their resources, technology access, and reimbursement options before launching a similar program.

The TelePR program ended when the research grant concluded and was not continued due to low insurance reimbursement, limited respiratory therapists staffing, and lack of consistent payment support for TelePR. Long-term sustainability of patient benefits was limited, once the structured exercise program and social interaction ended. Additional challenges included technology barriers in low-income communities, managing patients with serious conditions, and long wait lists for SPR. Sustaining this model would require integration into clinical services, leadership support, improved reimbursement, and ongoing follow-up programs.

• Plan for long-term funding and sustainability from the start
• Address transportation, insurance, and medical clearance barriers early
• Involve community members early to guide program design
• Use bilingual staff and ensure materials are translated and reviewed for accuracy
• Make technology simple and provide hands-on support
• Be flexible with scheduling for working older adults
• Recognize that social connection and peer support are important parts of care

Jennifer Polo, CCRC

Manager, Clinical Research - Northwell Health

Funded by the Patient-Centered Outcomes Research Institute (PCORI)