The pulmonary rehabilitation maze.

The difficulties in delivering patient-care services in a pulmonary rehabilitation program (PRP), especially in a program with a multidisciplinary approach, can usually be overcome by first conceptualizing and then organizing the PRP within a human-service-agency framework. All human-service agencies have six service components in common. The following are the components and their applicability to the Harper Hospital (Detroit, Michigan) PRP: (1) Outreach and Referral--local physicians are informed of the program and asked to send referrals; (2) Intake--initial information about the patient is gathered and his initial eligibility for the program is determined; (3) Assessment--more information about the patient is obtained, all data are organized for easy use and accessibility, and a final determination of eligibility is made; (4) Service Planning--needed service consultations are determined and obtained; (5) Service Delivery--during which a respiratory therapist serves as coordinator of the linkage of the various service subsystems and facilitates communication among them; (6) Follow-Up and Maintenance--at 1-month, 3-month, 6-month, and 1-year intervals and after each rehospitalization. Through evaluation of the program process and the program outcomes, PRP administrators can modify PRP structure and staffing to enhance the effectiveness of service delivery.