Hospital-admitted COPD patients treated at home using telemedicine technology in The Virtual Hospital Trial: methods of a randomized effectiveness trial

Abstract

Background: Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary disease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality of life. However, the studies are few and only involve COPD patients who are in a stable phase or in-patients who are ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine solutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute exacerbation of COPD at home as compared to conventional hospital treatment measured according to first treatment failure, which is defined as readmission due to COPD within 30 days after discharge.

Methods: COPD patients with acute exacerbation who fulfilled the eligibility criteria and were from two university hospitals in Denmark were randomized (1:1) by computer-generated tables that allocated treatments in blocks of four to receive either standard treatment at the hospital or the same standard treatment at home using telemedicine technology (that is, a video conference system with a touch screen and webcam and monitoring equipment (spirometer, thermometer, and pulse oximeter)). Patients treated in the telemedicine group were backed up by an organizational setting securing 24/7/365 online access to the hospital, as well as access to oxygen, nebulizer therapy, oral medical therapy and surveillance of vital parameters from home monitoring devices. Patients in both groups were discharged when clinically stable and when fulfilling five pre-specified discharge criteria. Follow-up was performed at 1, 3 and 6 months after discharge.

Results: Enrollment of patients started in June 2010 and ended in December 2011. Follow-up ended in May 2012. Results were analyzed in 2013.

Conclusions: The results may have implications on future hospital treatment modalities for patients with severe exacerbations in COPD where telemedicine may be used as an alternative to conventional admission.

Trial registration: Clinical Trials NCT01155856.

Figure 1

Photo of the telemedicine technology (TT) equipment used in the Virtual Hospital Trial (VHT). The photo illustrates the TT equipment used in the patients’ homes and consisted of the following items shown in the photo from left to right: The medicine box containing antibiotics, inhalation medicine, corticosteroids and sedatives; the electronic nebulizer used for inhalation medicine; the touch screen with a built-in webcam; the oxygen compressor on the far right standing on the floor;. the spirometer, pulse oximeter, and thermometer in front of the touch screen were used to send physiological measurements every day to the hospital. Also, the patient phone, which is carried by the nurse working in the acute emergency ward, is in front of the touch screen.