Readmissions to Hospital Among Patients With COPD After Telemedicine Video Consultation - a Pilot Project
Condition: Chronic Obstructive Pulmonary Disease (COPD)
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Observational

Summary: 
      The purpose of this study was to evaluate the effects of telemedicine video-consultation
      (TVC) on the frequency of hospital re-admissions during 12 months follow-up after TVC among
      patients with chronic obstructive pulmonary disease (COPD). Our secondary aims were to assess
      the impact of TVC on the length of recurrent hospital stays and time to re-admission within
      12 months follow-up after TVC. We also wanted to evaluate the patient satisfaction related to
      TVC.
    

Detailed description: 
      The study is conducted as a retrospective uni-center observation study of a population of
      COPD patients who after discharge from hospital for acute COPD exacerbation, or during
      outpatient treatment for acute COPD exacerbation, was monitored for 2 weeks by TVC during a
      pilot project period from 16 April 2010 to 31 December 2011. To study a possible change in
      amount of hospital admissions we have compared the frequencies and durations of such events
      before and after TVC in comparable time periods.

      A detailed patient history comprising demographic data, social status, smoking habits, body
      mass index (BMI), use of medication, co-morbidity and the habitual lung function were
      registered. Dates of admittance and discharge were noted. Retrospectively, medical records
      were scrutinized for re-admissions due to COPD exacerbations at 12 months follow-up.
      Frequency of and date of re-admissions, length of hospital stay, and clinical data were
      recorded. Also frequency of admission due to COPD exacerbation and length of hospital stay(s)
      during the last 12 months prior to the TVC were recorded, and date of last discharge was
      noted. Finally, all patients were encouraged to complete a questionnaire concerning patient
      satisfaction and impact on patient's quality of life. All answers were registered
      anonymously.

      Data were entered to a database by one trained nurse and monitored by another person, who
      compared data entered into the registry against predefined rules for range or consistency
      with other data fields in the registry. All patients who had been monitored by TVC during the
      pilot project period, gave informed consent to participate in the observational study, and no
      patient was lost to follow-up.

      Continuously distributed variables of baseline characteristics were given as mean + SEM,
      while variables with more skewed distributions were given as median and upper and lower
      quartiles.

      The Shapiro-Wilk test for normality was performed to study the distribution of parameters. A
      chi-square test was applied to compare the frequency of re-admissions during 12 months
      following TVC to the frequency of hospital admissions during the last 12 months prior to TVC.
      The total number of days in hospital during the last 12 months prior to TVC was compared to
      number of days in hospital during 12 months following TVC by a paired t-test. Differences in
      baseline characteristics between patients who were re-admitted and those who were not, were
      analyzed by a Two-sample Student's T-test, or in case of non-normality, by the Mann-Whitney
      Rank Sum test.

      The number of days to re-admission following TVC as compared to number of days from last
      discharge to date of index admittance was displayed in a Kaplan Meier plot, with a hazard
      ratio (HR) calculation by a by a Cox regression analysis.

      A statistically significant level of p < 0.05 was applied for all tests. All statistical
      analyses were performed using the statistical package of SigmaPlot Version 12.

      Power calculations have not been performed for the purpose of this pilot study, because of
      too many unknown factors. The results of this study will form the basis of power calculations
      for a future prospective randomized study.
    

Intervention name(s): Telemedicine video-consultation (TVC)
Intervention type(s): Device
Intervention description(s): All patients enrolled in the study, were previously monitored by TVC, and the number and length of hospital stays within 6 and 12 months following TVC were compared to similar numbers before TVC in comparable time periods. Thus, TVC is actually not to be considered as an intervention.
Other intervention name(s): Video-conferencing in Telemedicine
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        All COPD patients living in the southern part of Rogaland county in Western Norway, who
        were monitored at home by TVC following discharge after emergency hospitalization for COPD
        exacerbation at Stavanger University Hospital, or at Dalane Medical Center (DMC) in
        Egersund, or who had tele-monitoring at home under outpatient treatment for acute COPD
        deterioration during a pilot project period (16th April 2010 - 31st December 2011)
      
Keywords: Telemedicine video-consultation (TVC); Re-admission to hospital; Time to re-admission; Length if hospital stay; Patient satisfaction; Chronic obstructive pulmonary disease (COPD)