Abstract
BACKGROUND: Pulmonary rehabilitation is essential for patients with chronic obstructive pulmonary disease (COPD). However, pulmonary rehabilitation is often underutilized in COPD patients, primarily due to fragmented healthcare delivery systems and suboptimal patient compliance, contributing to recurrent hospital readmissions with a substantial economic healthcare system burden. We aimed to evaluate the impact of a novel WeChat-facilitated hospital-community-family integrated rehabilitation model on clinical outcomes and healthcare resource utilization in moderate to severe COPD patients. METHODS: A retrospective study involved eligible COPD patients discharged between January 2022 and January 2024. Patient information, including demographics, residence, marriage, weight, height, medical history, COPD stage, treatment regimens, and baseline pulmonary function, were collected. Propensity score matching was applied and patients were assigned into the integrated care group (a WeChat-based digital hub: hospital-community-family integrated care model) or traditional care group (standard pulmonary rehabilitation) at a 1:1 ratio. Pulmonary function (forced expiratory volume in one second, FEV1), quality of life (COPD assessment test, CAT), and exercise capacity (6-min walk test, 6MWT) six months after the hospital discharge, as well as healthcare utilization (readmission rates) and a preliminary economic assessment, were compared between two groups. RESULTS: A total of 253 patients were reviewed. After propensity score matching, 87 patients were included in each group. Inter-group baseline characteristics were comparable. Six months following rehabilitation, the integrated care group demonstrated significantly better outcomes in FEV₁ (53.2 ± 17.8 vs. 47.4 ± 19.8%), CAT score (9.1 ± 3.5 vs. 12.6 ± 4.1), and 6MWT (385.0 ± 33.7 vs. 374.1 ± 34.2 m) compared with the traditional care group. Readmission rates were significantly lower in the integrated care group (11.5% vs. 28.7%, P = 0.005). The integrated model resulted in a net economic benefit of Chinese Yuan 115,104 over six months, with a per-patient saving of Chinese Yuan 1,323.03. CONCLUSIONS: The WeChat-based digital hub model could improve lung function, enhance quality of life, reduce healthcare utilization costs, and lower healthcare cost, with greater exercise capacity in patients with moderate or severe COPD following hospital discharge. This study presents a scalable and economically attractive framework for optimizing COPD management by leveraging existing resources and technology. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-025-04083-0.