Background: The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is
unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions,
including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during
a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from
hospital following an exacerbation of their COPD.
Objective: The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify
an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital
readmission.
Methods: A total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from
a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral
devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth
monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was
required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident
and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service
contacts—other than the COPD discharge service—for all participants for the duration of the intervention and 6 months
postintervention.
Results: Patients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment.
Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day
thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports
of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and
for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of
service were lower than the 20% UK norm.
Conclusions: It seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of
system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth
monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain
out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)