Research studies have shown a significant reduction in hospitalizations and use of other acute healthcare services for patients using telehealth. With a high cost of COPD and COPD exacerbation, hospital systems have turned to telehealth to help improve outcomes. 




The Cost Of COPD Exacerbation

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospitalizations in the United States and the major cost driver of COPD. AECOPD are the principal reason for unscheduled visits and consequently, for increased healthcare resource utilization in COPD patients. The National Heart, Lung, and Blood Institute (NHLBI) estimated the national cost of hospital care across all cases of COPD in 2007 to be US$11.3 billion [1] and in one study of 1,254,703 cases of AECOPD within an inpatient setting the cost was estimated to be US $11.9 billion. [2]

Preventing AECOPD

Prompt detection and treatment of exacerbations may improve patient outcomes and reduce mortality making early detection of AECOPD a critical issue for healthcare organizations. A telehealth pilot study of 16 high-risk COPD patients sought to determine the effects that a mobile health system could have on the early detection of AECOPD on a day-to-day basis. Patients on telehealth were required to take vitals while also answering an automated questionnaire for COPD exacerbations (AQCE). These results were carefully monitored by clinicians.

The study concluded that the AQCE was able to early detect AECOPD with a margin of 4.5 ± 2.1 days prior to the medical attention for 15 of these patients making telehealth adoption desirable for high risk COPD patients.

Telehealth Adoption By Hospital Systems



Telehealth is used by hospital systems to provide continuous at home care for patients suffering from COPD. Telehealth is desirable because it helps overcome difficulties associated with hospital discharge and high cost of care. In addition, telehealth is used to identify disease worsening and improve accessibility to health services for high risk patients.

While research has been inconclusive over the benefits of telehealth for COPD patients, a review of 46 randomized controlled trials (RCT) from 2003 to 2017 provided great insight into how telehealth can benefit COPD patients. All studies reviewed consisted of a control group—where patients were monitored by a general practitioner (GP) while receiving significant home care support –and an experimental group—which consisted of COPD patients who were on second generation or third generation telehealth. Second generation telehealth referred to synchronized data transfer (automated algorithms can recognize important changes, but delays can occur if the systems are not active 24 h/ day) and third generation telehealth consisted of constant analytical and decision-making support in which monitoring centers have full therapeutic authority 24 h/day, 7 days/week.

Most reviewed research studies showed a significant reduction in hospitalizations and use of other acute healthcare services for patients using second and third generation telehealth compared to the control groups. In addition, all studies showed an improvement in the quality of life and patient satisfaction.

These program results were due to strict adherence to care interventions by patients and their caregivers, while clinicians acted as strong liaisons between primary care providers and hospital services. What was critical to the study was the delivery of time-intensive education by nurses and other personnel such as a respiratory therapist.

The study analysis showed that the best telehealth outcomes for the experimental groups were based on providing third generation telehealth where constant feedback was provided between patient and clinician for patients who are elderly and very sick from COPD, specifically those that have severe symptoms, frequent exacerbations, and comorbidities.

Beyond Telehealth Technology

Overall the study concluded that while telehealth is undeniably beneficial for COPD patients, the successful implementation of telehealth is dependent upon developing a unique patient-centered approach that is flexible and locally responsive. 

While there are barriers to telehealth implementation, telehealth provides a framework for patient engagement, real time data access, and a new possibility for integrated healthcare among clinicians. The authors of the research study also determined that the common prerequisite for the efficacy of telemonitoring in COPD management is to establish common standardized protocols rather than determine how to deliver the care. Telemonitoring, they concluded, provides benefits in addition to a strong existing support system.

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[1] National Institutes of Health, National Heart, Lung, and Blood Institute. Morbidity and mortality: 2007 chart book on cardiovascular, lung, and blood diseases [Internet]. National Heart, Lung, and Blood Institute; 2007 June [cited 2011 Jun 30]. Available from: docs/07-chtbk.pdf

[2] Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute Exacerbations of COPD in the United States: Inpatient Burden and Predictors of Costs and Mortality. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2012;9(2):131-141. 

[2] Sanchez-Morillo, D., Fernandez-Granero, M. and Jiménez, A. (2015). Detecting COPD exacerbations early using daily telemonitoring of symptoms and k-means clustering: a pilot study. Medical & Biological Engineering & Computing, 53(5), pp.441-451.