通过电子健康计划减少慢性阻塞性肺疾病急性加重导致的住院率：一项回顾性研究。
eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study.
作者信息
van Buul Amanda R, Derksen Caroline, Hoedemaker Ouke, van Dijk Oscar, Chavannes Niels H, Kasteleyn Marise J
机构信息
Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands.
Bravis, Department of Pulmonology, Roosendaal, Netherlands.
出版信息
JMIR Form Res. 2021 Mar 18;5(3):e24726. doi: 10.2196/24726.
BACKGROUND
Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. eHealth interventions might improve outcomes and decrease costs.
OBJECTIVE
This study aimed to evaluate the effect of an eHealth program on COPD hospitalizations and exacerbations.
METHODS
This was a real-world study conducted from April 2018 to December 2019 in the Bravis Hospital, the Netherlands. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations. Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. Generalized estimating equations were used to compare the number of days admitted to the hospital and the total number of exacerbations 12 months before and (max) 18 months after the start of EmmaCOPD. We additionally adjusted for the potential confounders of age, sex, COPD severity, and inhaled corticosteroid use.
RESULTS
The 29 included patients had a mean forced expiratory volume in 1 second of 45.5 (SD 17.7) %predicted. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). The median number of hospitalized days was 8.0 days (IQR 6.0-16.5 days). Afterwards, there was a median 1.0 (IQR 0.0-2.0) exacerbation and 2.0 days (IQR 0.0-4.0 days) of hospitalization. After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95% CI 0.116-0.382; incidence rate ratio 0.310, 95% CI 0.219-0.438). Adjustment for confounders did not affect the results.
CONCLUSIONS
The eHealth program seems to reduce the number of total exacerbations and number of days of hospitalization due to exacerbations of COPD.
背景
慢性阻塞性肺疾病（COPD）急性加重导致的住院与预后不良相关。电子健康干预措施可能会改善治疗结果并降低成本。
目的
本研究旨在评估一项电子健康计划对COPD住院和急性加重的影响。
方法
这是一项于2018年4月至2019年12月在荷兰布拉维斯医院进行的真实世界研究。为有急性加重风险的COPD患者提供了一项电子健康计划（EmmaCOPD）。EmmaCOPD包括一个应用程序，该应用程序使用问卷（以监测症状）和计步器（以监测步数）来检测急性加重。当患者及其伙伴的症状恶化或步数减少时，他们会收到反馈。使用广义估计方程比较EmmaCOPD开始前12个月和开始后（最长）18个月的住院天数和急性加重总数。我们还对年龄、性别、COPD严重程度和吸入性糖皮质激素使用等潜在混杂因素进行了调整。
结果
纳入的29例患者的一秒用力呼气量平均为预测值的45.5%（标准差17.7%）。在干预前的一年中，急性加重的总数中位数为2.0（四分位间距2.0 - 3.0）。住院天数中位数为8.0天（四分位间距6.0 - 16.5天）。之后，急性加重的中位数为1.0（四分位间距0.0 - 2.0），住院天数为2.0天（四分位间距0.0 - 4.0天）。启动EmmaCOPD后，住院天数和急性加重总数均显著减少（发病率比0.209，95%置信区间0.116 - 0.382；发病率比0.310，95%置信区间0.219 - 0.438）。对混杂因素的调整并未影响结果。
结论
电子健康计划似乎减少了COPD急性加重导致的急性加重总数和住院天数。
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