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Abstract

Chronic obstructive pulmonary disease (COPD) places a high burden on patients and healthcare systems due to frequent emergency department visits, hospitalizations, and reduced quality of life. Community-based pulmonary rehabilitation has been proposed as a way to improve patient outcomes while reducing reliance on acute care. This study evaluated a community-based COPD intervention implemented in the Cowichan Valley, British Columbia. A retrospective pre-post study design was used from a government payer perspective. Administrative health data were analyzed for 185 patients who participated in the program between January 2023 and March 2024. Healthcare utilization outcomes included emergency department visits, hospitalizations, and inpatient bed-days measured over matched nine-month pre- and post-intervention periods. A two-part generalized linear mixed-effects hurdle model was applied. Program costs were estimated using direct resource inputs, including staffing, equipment, and travel. Health-related quality of life was assessed using the EQ-5D-3L among the newly enrolled patients (Prospective interview), with analyses stratified by follow-up duration. Following the intervention, significant reductions were observed in the likelihood of emergency department visits, hospitalizations, and inpatient bed-days, for both all-cause and COPD-related outcomes. These reductions led to lower overall healthcare costs in the post-intervention period, even after accounting for program delivery costs. The estimated program cost per patient was modest relative to the downstream costs avoided through reduced acute care use. Quality-of-life improvements were observed among participants at six months of follow-up, while no meaningful change was detected at three months. When all participants were considered together, overall changes in health utility were positive but not statistically significant. Overall, the findings suggest that community-based pulmonary rehabilitation may reduce acute healthcare utilization and costs, with potential quality-of-life benefits over longer follow-up periods. Patient and physician feedback highlighted improved disease understanding, confidence in self-management, and better coordination of care. These results support the value of community-based pulmonary rehabilitation as part of chronic disease management for COPD.