Active control- standard pulmonary rehabilitation
For those enrolled in the SPR arm, two SPR sites were made available to participants within the study geographic area: Northwell Health Physician Partners Pulmonary and Sleep Medicine at Lake Success, New York and Glen Cove Hospital Outpatient Pulmonary Rehabilitation Program, Glen Cove, New York. We recruited patients within the metropolitan New York area – depending on where the patients lived – these centers were either within a 20 min or 1 h commute for patients. SPR facilities are equipped with exercise equipment, vital sign monitors, and supplemental oxygen devices, and are staffed by a team of RTs, other clinicians, and administrators. Educational lectures are given as part of the PR sessions.Participants in both arms received $175 for their time completing longitudinal surveys. TelePR was provided at no cost to the participant. However, participants in SPR were required to pay co-payments based on insurance laws and SPR was charged to participants’ health insurance.TelePR was provided at no cost to the patient; however, SPR was charged to participants’ health insurance, and co-payments were required. Both arms needed to have medical clearance appointments submitted to their insurance carriers and to pay co-payments when applicable. During the initial consent (consent form 1), all participants were made aware of this real-world requirement for SPR. It was not until the participant was randomly assigned to TelePR that the research team explained that the intervention could not be paid for by insurance and therefore would be paid by the study grant. Before the start of the program, the social worker and research team had discussed sliding-scale payment options with the health system and worked closely with the medical billing departments to assist with insurance navigation for participants.Transportation costs were covered to and from clinic visits for medical clearance appointments and the SPR sessions. When possible, the social worker attempted to leverage existing insurance-subsidized transportation programs to offset the cost to the patient.