Evaluation of Home Automated Telemanagement in COPD

描述（由申请人提供）：增强患者自我管理和增加患者对其慢性疾病的了解的干预措施已被证明可以减少紧急护理的利用并提高患者的生活质量。迄今为止，还没有针对慢性阻塞性肺疾病（COPD）患者的自我管理干预措施的研究，这些研究利用了当前的电信技术进展，旨在促进慢性阻塞性肺疾病全球倡议（GOLD）在常规临床实践中的实施。基于互联网的家庭自动化远程管理（HAT）系统旨在支持患者自我管理的多学科方法，包括定期患者评估、针对疾病的教育、控制患者对治疗计划的依从性、实施健康行为改变模型以及为患者和护理人员提供社会支持。在本提案中，我们将(1)完善HAT系统以全面实施COPD患者远程管理的多学科模式(2)在可行性研究中评估HAT对COPD患者医疗护理的临床影响程度。患者将在家中安装HAT装置（连接肺活量计和脉搏血氧计的联网计算机），并指导如何使用。他们将被要求定期进行自我测试，并在电脑屏幕上回答问题（症状、药物使用和其他自我保健行为）。每次HAT会议将包括(1)患者评估（自动下载到计算机的客观测量，如FEV1或SaO2，以及患者报告的参数，如呼吸道症状和药物使用），(2)根据患者医生生成的个性化治疗方案进行解释和建议，(3)有组织的COPD教育，(4)患者咨询和健康行为调整（基于社会认知理论的主要结构）。(5)社会支持（虚拟患者群体、与社工的沟通）、(6)可选的直接通信会话（家庭运动监督、医生/护士使用网络摄像头视频会议远程访问）。一项随机临床研究将对280名COPD患者进行为期18个月的随访。结果参数将包括生活质量、医疗保健利用、ADL、治疗依从性、呼吸道症状和心理社会变量。患者和临床医生对HAT的态度和关注将使用定性研究方法和标准化问卷进行评估。最后，我们将对HAT干预COPD患者的成本-效果进行分析。

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.