Evaluation of Home Automated Telemanagement in COPD

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DESCRIPTION (provided by applicant): Interventions that enhance patient self-management and increase patient understanding of their chronic disease have been shown to reduce urgent care utilization and improve patients' quality of life. To date there have been no studies of self-management interventions for patients with Chronic Obstructive Pulmonary Disease (COPD) that have employed current advances in telecommunication technologies aimed to facilitate implementation of Global Initiative for Chronic Obstructive Lung Disease (GOLD) into routine clinical practice. The Internet-based Home Automated Telemanagement (HAT) system was designed to support a multi-disciplinary approach in patient self-management which includes regular patient assessment, disease-specific education, control of patient compliance with treatment plans, implementation of health behavior change models and social support both for patients and caregivers. In this proposal we will (1) refine the HAT System to fully implement the multidisciplinary model for telemanagement of COPD patients (2) evaluate in a feasibility study the magnitude of clinical impact of HAT on medical care of COPD patients. Patients will have the HAT units (Internet-enabled computer connected to spirometer and pulse oximeter) installed in their homes and will be instructed how to use it. They will be asked to do self-testing on a regular basis and to answer questions on their computer screen (symptoms, medication use, and other self-care actions). Each HAT session will include (1) patient assessment (objective measurements such as FEV1 or SaO2, which are automatically downloaded to the computer, and patient-reported parameters such as respiratory symptoms and medication use), (2) interpretation and advice according to individualized treatment plan generated by patient's physician, (3) structured COPD education, (4) patient counseling and health behavior adjustment (based on main constructs of Social Cognitive Theory, such as behavioral capability, self-efficacy, outcome expectations and reinforcement), (5) social support (virtual patient groups, communication with social worker), (6) optional direct telecommunication sessions (home exercise supervision, physician/nurse tele-visit using a web cam video-conferencing). A randomized clinical study will be conducted with 280 COPD patients who will be followed for 18 months. The outcome parameters will include quality of life, medical care utilization, ADL, treatment compliance, respiratory symptoms and psychosocial variables. Patient and clinician attitudes and concerns regarding HAT will be evaluated using qualitative research methods and standardized questionnaires. Finally, we will perform cost-effectiveness analysis of the HAT intervention in the COPD patients.