BACKGROUND
Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death and is characterized by a progressive loss of pulmonary function over time with intermittent episodes of exacerbations. Rapid and proactive interventions may reduce the burden of the condition for the patients. Telehealth solutions involving self-tracking of vital parameters such as pulmonary function, oxygen saturation, heart rate and temperature with synchronous communication of health data may become a powerful solution as they enable healthcare professionals to react with a pro-active and adequate response. We have taken this idea to the next level in the Epital Care Model (ECM) and organized a person-centered technology assisted ecosystem to provide health services to COPD patients.
OBJECTIVE
The objective is to reveal the nature of COPD by combining technology with a person-centered design aimed to benefit from interactions based on PRO data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know: 1) What is the incidence of mild, moderate and severe exacerbations in a mixed population of COPD patients? 2) What is the course of the mild, moderate and severe exacerbations? And 3) How is the activity and pattern of contacts to health professionals related to the participants condition?
METHODS
Convenience sampling during the period November 2013 to December 2015. The participants’ sex, age, FEV1, pulse rate and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, number of contact notes coded into care and treatment notes. Each participant was classified according to GOLD I-IV and risk factor group A-D. Participants reported their clinical status using a tablet by answering four questions and sending three semi-automated measurements.
RESULTS
Of the 87 participants, 11 were in risk factor group A, 24 in B, 13 in C and 39 in D. The number of observed days was 31801 days with 12470 measurements and 1397 care notes and 1704 treatment notes. A total of 254 exacerbations were treated and only 18 caused hospitalization. Those in risk factor group D have the highest number of hospitalizations (16), exacerbations (151), and contacts (1910) The initial contacts during the first month declined within three months to 1/3 for care contacts and 1/2 for treatment contacts and reached a plateau after four months.
CONCLUSIONS
The majority of COPD patients in risk factor group D can be managed virtually and only 13% of those with severe exacerbations required hospitalization. Contact to the healthcare professionals decreases markedly within the first months after enrollment. These results provide a new and detailed insight into the course of COPD. We propose a resilience index for virtual clinical management making it easier to compare results across settings.
On some generalizations of Baer's theorem
