Epital Health, Gentofte, Denmark.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
J Med Internet Res. 2021 Oct 19;23(10):e22567. doi: 10.2196/22567.
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.
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?
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.
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.
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.
慢性阻塞性肺疾病（COPD）是第四大致死原因，其特征是随着时间的推移，肺功能逐渐丧失，并伴有间歇性加重。快速和积极的干预措施可能会减轻患者的病情负担。涉及自我跟踪生命参数（如肺功能、血氧饱和度、心率和体温）的远程医疗解决方案，并同步传输健康数据，这可能成为一种强大的解决方案，因为它们使医疗保健专业人员能够做出积极和充分的反应。我们在 Epital Care 模型中进一步发展了这一理念，并组织了一个以患者为中心的技术辅助生态系统，为 COPD 患者提供医疗服务。
通过结合以人为中心的设计和技术，揭示 COPD 的本质，旨在从基于患者报告结果数据的交互中受益，并评估治疗加重症所需的最佳联系方式。我们想知道以下问题：（1）混合 COPD 患者群体中轻度、中度和重度加重的发生率是多少？（2）轻度、中度和重度加重的过程是怎样的？（3）与参与者病情相关的活动和与健康专业人员联系的模式是怎样的？
参与者通过方便抽样于 2013 年 11 月至 2015 年 12 月被招募。参与者的性别、年龄、第一秒用力呼气量、脉搏率和血氧饱和度在入组时进行登记。在研究期间，我们登记了天数、加重次数和编码为护理和治疗记录的联系记录数。每位参与者根据 GOLD I-IV 和危险因素 A-D 组进行分类。参与者通过回答 4 个问题和发送 3 个半自动测量值，使用平板电脑报告其临床状况。
在 87 名参与者中，有 11 名处于危险因素 A 组，24 名处于 B 组，13 名处于 C 组，39 名处于 D 组。观察天数为 31801 天，共进行了 12470 次测量、1397 次护理记录和 1704 次治疗记录。共治疗了 254 次加重，仅有 18 次导致住院。危险因素 D 组的住院人数（16 人）、加重人数（151 人）和联系人数（1910 人）最多。第一个月的初始联系在 3 个月内下降到护理联系的三分之一和治疗联系的一半，并在 4 个月后达到稳定水平。
大多数处于危险因素 D 组的 COPD 患者可以进行虚拟管理，只有 13%的重度加重患者需要住院治疗。在入组后的头几个月内，与医疗保健专业人员的联系显著减少。这些结果提供了对 COPD 病程的新的、详细的了解。我们提出了一个虚拟临床管理的弹性指数，使结果更容易在不同环境中进行比较。
