Outcomes of a telemonitoring-based program (telEPOC) in frequently hospitalized COPD patients.
BACKGROUND
The increasing prevalence of chronic diseases requires changes in health care delivery. In COPD, telemedicine appears to be a useful tool. Our objective was to evaluate the efficacy (in improving health care-resource use and clinical outcomes) of a telemonitoring-based program (telEPOC) in COPD patients with frequent hospitalizations.


MATERIALS AND METHODS
We conducted a nonrandomized observational study in an intervention cohort of 119 patients (Galdakao-Usansolo Hospital) and a control cohort of 78 patients (Cruces Hospital), followed up for 2 years (ClinicalTrials.gov identifier: NCT02528370). The inclusion criteria were two or more hospital admissions in the previous year or three or more admissions in the previous 2 years. The intervention group received telemonitoring plus education and controls usual care.


RESULTS
Most participants were men (13% women), and the sample had a mean age of 70 years, forced expiratory volume in 1 second of 45%, Charlson comorbidity index score of 3.5, and BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index score of 4.1. In multivariate analysis, the intervention was independently related to lower rates of hospital admission (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.27-0.54; P<0.0001), emergency department attendance (OR 0.56, 95% CI 0.35-0.92; P<0.02), and 30-day readmission (OR 0.46, 95% CI 0.29-0.74; P<0.001), as well as cumulative length of stay (OR 0.58, 95% CI 0.46-0.73; P<0.0001). The intervention was independently related to changes in several clinical variables during the 2-year follow-up.


CONCLUSION
An intervention including telemonitoring and education was able to reduce the health care-resource use and stabilize the clinical condition of frequently admitted COPD patients.
['Esteban|Cristóbal|C|', 'Moraza|Javier|J|', 'Iriberri|Milagros|M|', 'Aguirre|Urko|U|', 'Goiria|Begoña|B|', 'Quintana|José M|JM|', 'Aburto|Myriam|M|', 'Capelastegui|Alberto|A|']
D000368:Aged D016022:Case-Control Studies D016009:Chi-Square Distribution D019033:Delivery of Health Care, Integrated D017079:Exercise Tolerance D005260:Female D005541:Forced Expiratory Volume D007722:Health Knowledge, Attitudes, Practice D006295:Health Resources D006304:Health Status D006801:Humans D016014:Linear Models D008168:Lung D008297:Male D008875:Middle Aged D063731:Mobile Applications D015999:Multivariate Analysis D016017:Odds Ratio D010353:Patient Education as Topic D010359:Patient Readmission D015397:Program Evaluation D029424:Pulmonary Disease, Chronic Obstructive D058998:Remote Sensing Technology D012307:Risk Factors D000068997:Smartphone D013030:Spain D011795:Surveys and Questionnaires D017216:Telemedicine D013686:Telemetry D013997:Time Factors D016896:Treatment Outcome D014797:Vital Capacity
hospitalizations COPD telemonitoring program