JMIR Publications

ABSTRACT

Background:

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of mortality worldwide. Reducing the number of COPD exacerbations is an important patient outcome and a major cost saving approach. Both technology-enabled self-monitoring (SM) and remote monitoring (RM) programs have the potential to reduce exacerbations, but they have not been directly compared to each other. Since RM is a more resource intensive strategy, it is important to understand whether it is more effective than SM. The goal of this study is to compare the use of two technology-enabled strategies for COPD relative to standard of care: SM alone and SM with RM by a health professional.

Methods:

Patients in the SM and RM groups record their vital signs (oxygen, blood pressure, temperature and weight) and symptoms with the Cloud DX platform every day and are provided with a COPD action-plan. Patients in RM group also receive access to a respiratory therapist (RT). The RT monitors their vital signs intermittently and contacting them when their vitals vary outside of pre-determined thresholds. The RT also contacts patients once a week irrespective of their vital signs or symptoms. All patients were recruited from a community based hospital and randomized to one of the three groups and assessed at baseline, 3 and 6 months after program initiation. The primary outcome is the Partners in Health (PIH) scale, which measures self-management skills. Secondary outcomes include the St. George's Respiratory Questionnaire (SGRQ), the Bristol COPD Knowledge Questionnaire, the COPD Assessment Test and the Modified-Medical Research Council (mMRC) Breathlessness Scale. Patients are also asked to self-report on health system usage. Ethics and Dissemination: The study has been approved by hospital research ethics boards and retrospectively registered with clinicaltrials.gov (NCT03741855). Discussion: Both self-management and remote monitoring have shown promise in reducing acute care utilization and exacerbation frequencies. As far as we are aware, no studies to date have directly compared technology-enabled self-management versus remote monitoring programs. The goal of this study is to evaluate the impact of these programs as it relates to self-management behaviors, COPD disease knowledge and respiratory status.