Revealing the Nature of Chronic Obstructive Pulmonary Disease Using Self-tracking and Analysis of Contact Patterns: Longitudinal Study

Abstract

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 health care professionals to react with a proactive and adequate response. We have taken this idea to the next level in the Epital Care Model 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 patient-reported outcome data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know the following: (1) What are the incidences of mild, moderate, and severe exacerbations in a mixed population of COPD patients? (2) What are the courses of mild, moderate, and severe exacerbations? And (3) How is the activity and pattern of contacts with health professionals related to the participant conditions? Methods Participants were recruited by convenience sampling from November 2013 to December 2015. The participants’ sex, age, forced expiratory volume during the first second, pulse rate, and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, and 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 4 questions and sending 3 semiautomated 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 31,801 days with 12,470 measurements, 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 had the highest number of hospitalizations (16), exacerbations (151), and contacts (1910). The initial contacts during the first month declined within 3 months to one-third for care contacts and one-half for treatment contacts and reached a plateau after 4 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 health care 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.

Experiences With In-Person and Virtual Health Care Services for People With Chronic Obstructive Pulmonary Disease: Qualitative Study

“…The model is designed to promote integrated people-centered health service and facilitate engagement, self-management, and empowerment of patients, and has been iteratively developed and tested since 2012. The ECM is described in more detail elsewhere [ 11 , 21 , 35 ]. The current implementation of the ECM has focused on the medical treatment of COPD and less on rehabilitation and services from allied health professionals such as occupational therapists, physical therapists, dietitians, and health coaches, despite all these being part of the conceptual framework of the ECM [ 10 ].…”

“…The motivation for this study originated from our previous work concerning the development and implementation of a 24/7 telemedicine service for individuals with COPD [ 10 ]. In this work we, among others, discuss the extent, as well as the related challenges, to which virtual and in-person services can most efficiently be combined to offer a digitally assisted active and independent living that meets the needs, preferences, and values of people with COPD [ 10 , 11 ]. To better understand this concept, we will build on a recently developed model, the Readiness and Enablement Index for Health Technology (READHY) [ 12 - 14 ], as a theoretical framework that helps us to enlighten aspects of the role of support by peers and professionals, their digital health literacy, and their ability to self-manage.…”

“…It is generally believed that digital tools can promote patient empowerment by enhancing the one’s ability to understand and influence their own health status, enabling distant clinical support, and increasing the ability to manage the disease in an at-home setting [ 11 , 20 ]. This is in contrast to our recent study, where we found that participants in a 24/7 accessible virtual response and coordination center (RCC) service felt less active over time in managing their health [ 21 ].…”