Teresi Robert K, Hendricks Ashley C, Moraveji Neema, Murray Richard K, Polsky Michael, Maselli Diego J
Research Department, Spire Health, San Francisco, California, United States.
Pulmonary Associates of Richmond, Richmond, Virgnia, United States.
Chronic Obstr Pulm Dis. 2024 Nov 22;11(6):558-568. doi: 10.15326/jcopdf.2023.0475.
Continuous respiratory monitoring can support integrated care for chronic obstructive pulmonary disease (COPD) patients, by coupling them with remote clinical personnel who triage patients in coordination with their health care providers. When deploying such services, there remains uncertainty surrounding outcomes when at-risk patients are proactively identified and escalated for provider evaluation. This study presents findings from a service deployed in a real-world COPD cohort by analyzing the clinical interventions made during in-person and telehealth pulmonary outpatient visits following remote escalations.
A single-center, retrospective, observational study of real-world COPD patients at a multisite pulmonary practice was conducted. Patients who were enrolled in a continuous respiratory monitoring service for at least one year and were seen by a provider within 7 days of an escalation by the service (N=168) were included. To evaluate the potential impact of these escalations on provider and patient burden, medical charts from outpatient visits were manually reviewed and grouped into 6 categories based on the clinical action(s) taken by the provider.
A total of 245 outpatient visits occurred from 168 patients within 7 days of escalation. Of the 245 visits, 206 (84.1%) resulted in clinical intervention and 163 (66.5%) resulted in treatment consistent with acute exacerbations of COPD. A total of 1.6% of the outpatient visits resulted in referral to the emergency department.
Provider encounters occurring following the escalation of a patient from a continuous respiratory monitoring service consistently resulted in that provider administering a treatment to the escalated patient.
持续呼吸监测可通过将慢性阻塞性肺疾病（COPD）患者与远程临床人员相结合，支持对他们的综合护理，这些临床人员会与患者的医疗服务提供者协调对患者进行分类。在部署此类服务时，当主动识别出高危患者并将其转诊给医疗服务提供者进行评估时，结果仍存在不确定性。本研究通过分析远程转诊后面对面和远程医疗肺部门诊就诊期间进行的临床干预，展示了在一个真实世界的COPD队列中部署的一项服务的研究结果。
对一个多地点肺部诊疗机构的真实世界COPD患者进行了一项单中心、回顾性、观察性研究。纳入了参加持续呼吸监测服务至少一年且在服务转诊后7天内接受医疗服务提供者诊治的患者（N = 168）。为了评估这些转诊对医疗服务提供者和患者负担的潜在影响，人工查阅门诊就诊的病历，并根据医疗服务提供者采取的临床行动将其分为6类。
168名患者在转诊后7天内共进行了245次门诊就诊。在这245次就诊中，206次（8４.1%）导致了临床干预，163次（66.5%）导致了与COPD急性加重相一致的治疗。共有1.6%的门诊就诊导致转诊至急诊科。
患者从持续呼吸监测服务转诊后进行的医疗服务提供者会诊一致导致该医疗服务提供者对转诊患者进行治疗。
