Remote monitoring reduced hospitalization rates and emergency room visits for patients with chronic obstructive pulmonary disease (COPD), a recent study has shown.
At the same time, outpatient office visits increased, suggesting remote patient monitoring may help shift care to a less expensive and burdensome setting.
“These results support the potential of [remote monitoring] to improve the long-term management of COPD and reduce acute healthcare utilization,” the researchers wrote in “Use of Remote Cardiorespiratory Monitoring is Associated with a Reduction in Hospitalizations for Subjects with COPD,” which was published in the International Journal of Chronic Obstructive Pulmonary Disease.
COPD is a chronic inflammatory lung disease marked by airway blockage due to long-term exposure to lung irritants, particularly cigarette smoke.
Acute COPD exacerbations, or episodes of sudden symptom worsening, have a large effect on patients’ health as they’ve been associated with a higher risk of hospitalization and disease progression.
If identified and treated early, these episodes can be managed with medications, such as bronchodilators (medicines that help relax and open the airways), antibiotics, oral steroids, and other therapies such as oxygen therapy, pulmonary rehabilitation, and noninvasive ventilation.
Hospital admissions decrease with remote patient monitoring
In this study (NCT05518981), researchers studied whether sustained remote patient monitoring contributed to identifying exacerbations early, improved patients’ healthcare and lowered hospitalization rates.
They retrospectively analyzed data from 126 COPD patients (mean age, 73.8) from a large outpatient pulmonary practice in San Francisco between May 2019 and February 2022. The patients were monitored for two years — before initiating monitoring and after starting it.
The remote monitoring service, which was tailored to COPD patients, included three components — undergarment-adhered cardiorespiratory sensors, an in-home data transmission hub, and a web-based clinical dashboard.
Sensors communicated wirelessly with a data transmission hub at home, which sent the data to a cloud-based dashboard assessed by the medical team. The dashboard displayed notifications if respiratory and pulse rates increased by 10% and 20%, respectively, above each patient’s baseline, or when 35 breaths per minute or 135 beats a minute were exceeded.
When comparing the year before using the remote system with the year after, researchers found the total number of all-cause hospital admissions decreased from 137 to 48, a 65% reduction. Per patient, the total number of all-cause hospitalizations also dropped significantly from a mean of 1.09 to 0.38.
The total number of hospitalizations due to cardiopulmonary events, such as chest pain, shortness of breath, or pneumonia, also decreased significantly — from 88 before remote monitoring to 32 after — a 63.6% drop. Per patient, the mean number of cardiopulmonary hospitalizations also fell significantly from 0.7 to 0.25.
Although the length of hospital stays tended to be shorter in the year after remote monitoring, the differences weren’t considered statistically significant.
“We hypothesize that [remote patient monitoring] may have led to subjects being treated earlier for exacerbations than they may have otherwise, which has been shown to improve outcomes,” the researchers wrote, attributing them to “low patient burden, high adherence rates, and … benefits of continuous monitoring of parameters directly relevant to [acute COPD exacerbations] … which may allow for earlier detection of exacerbations.”
ER visits fall, outpatient visits rise
The number of all-cause emergency room (ER) visits also dropped from 61 to 34, corresponding to a significant 44% reduction, a drop from a mean of 0.48 to 0.27 per patient. Similarly, the number of cardiopulmonary-related ER visits decreased from 36 to 20, corresponding to a significant 44.4% drop (from a mean of 0.29 to 0.16 per patient).
The total number of outpatient care visits increased by 13.2% (from 532 to 602), corresponding to an increase from a mean of 4.22 to 4.78 visits per patient. The total number of prescribed steroids increased by 3.4% — from 116 to 120.
The adherence to using the sensors for remote monitoring was high, with patients adhering 88.6% of the days. Adherent days were defined as those when the sensors were worn for at least eight hours. Most of the patients were adherent 90% or more of the year after the remote monitoring was implemented. Adherence tended to decrease with time, however.
“The results from this study are preliminary evidence of improved clinical outcomes. The shift observed to less acute care also suggests support for earlier intervention as a proposed mechanism,” the researchers wrote, noting more research with a control group would help validate their findings.