Ding Hang, Fatehi Farhad, Maiorana Andrew, Bashi Nazli, Hu Wenbiao, Edwards Iain
The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Brisbane, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, Australia.
J Thorac Dis. 2019 Oct;11(Suppl 17):S2210-S2220. doi: 10.21037/jtd.2019.10.17.
Chronic obstructive pulmonary disease (COPD) imposes a huge burden to our healthcare systems and societies. To alleviate the burden, digital health-"the use of digital technologies for health"-has been recognized as a potential solution for improving COPD care at scale. The aim of this review is to provide an overview of digital health interventions in COPD care. We accordingly reviewed recent and emerging evidence on digital transformation approaches for COPD care focusing on (I) self-management, (II) in-hospital care, (III) post-discharge care, (IV) hospital-at-home, (V) ambient environment, and (VI) public health surveillance. The emerging approaches included digital-technology-enabled homecare programs, electronic records, big data analytics, and environment-monitoring applications. The digital health approaches of telemonitoring, telehealth and mHealth support the self-management, post-discharge care, and hospital-at-home strategy, with prospective effects on reducing acute COPD exacerbations and hospitalizations. Electronic records and classification tools have been implemented; and their effectiveness needs to be further evaluated in future studies. Air pollution concentrations in the ambient environment are associated with declined lung functions and increased risks for hospitalization and mortality. In all the digital transformation approaches, clinical evidence on reducing mortality, the ultimate goal of digital health intervention, is often inconsistent or insufficient. Digital health transformation provides great opportunities for clinical innovations and discovery of new intervention strategies. Further research remains needed for achieving reliable improvements in clinical outcomes and cost-benefits in future studies.
慢性阻塞性肺疾病（COPD）给我们的医疗系统和社会带来了巨大负担。为了减轻这一负担，数字健康——“利用数字技术促进健康”——已被视为大规模改善COPD护理的一种潜在解决方案。本综述的目的是概述数字健康在COPD护理中的干预措施。因此，我们回顾了关于COPD护理数字转型方法的最新和新出现的证据，重点关注（I）自我管理、（II）住院护理、（III）出院后护理、（IV）居家医院、（V）周围环境和（VI）公共卫生监测。新出现的方法包括数字技术支持的家庭护理项目、电子记录、大数据分析和环境监测应用。远程监测、远程医疗和移动健康等数字健康方法支持自我管理、出院后护理和居家医院策略，对减少急性COPD加重和住院有预期效果。电子记录和分类工具已经实施；其有效性需要在未来的研究中进一步评估。周围环境中的空气污染浓度与肺功能下降以及住院和死亡风险增加有关。在所有数字转型方法中，关于降低死亡率（数字健康干预的最终目标）的临床证据往往不一致或不足。数字健康转型为临床创新和发现新的干预策略提供了巨大机遇。未来的研究仍需要进一步开展，以在临床结果和成本效益方面实现可靠的改善。
