Early Assisted Discharge for COPD Exacerbations With Telemonitoring.

Study Overview
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Brief Summary
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To determine if an early assisted discharge program for acute exacerbations of COPD (AECOPD), with telemonitoring and telephone control, is equally effective and more efficient in terms of use of health care resources, that a home care provided by hospital respiratory nurses and pulmonologists.

Detailed Description
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This study seeks to improve the health of patients with AECOPD by home care after discharge from the Hospital using the technology of the information and the communication. The investigators want evaluate the efficiency, satisfaction (patients, keepers) and effectiveness of a program of early discharge with home care in patients with AECOPD with telemonitoring and telephone control, in relation to the traditional protocol of home care based on nurse and pulmonologist visits.

Official Title
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Early Assisted Discharge With Generic Community Nursing and Pulmonary Physicians vs Telemonitoring at Home for Chronic Obstructive Pulmonary Disease Exacerbations

Conditions
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COPD Exacerbation

Intervention / Treatment
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* Procedure: Telemonitoring and telephone control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted to the hospital with COPD exacerbation No concomitant serious unstable diseases Without fever in 48 hours Aerosol treatment at the most every 6 hours Treatment with glucocorticoid intravenous < 40 mg twice a day A thoracic radiograph without new disease Subjective improvement of the patient Familiar suitable environment Exclusion Criteria: Neoplasias and other chronic diseases in terminal situation Alcoholism Intravenous medication Disability to understand and take part in the program Admitted to intensive care unit (ICU) or non invasive mechanical ventilation during the exacerbation Unstability hemodynamic To be an institutionalized patient.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: telemonitoring and telephone control<br>Early discharge from hospital with telemonitoring, telephone control and three nurse scheduled visits. | Procedure: Telemonitoring and telephone control<br>* Early assisted discharge from hospital due to an exacerbation of chronic obstructive pulmonary disease, with telemonitoring of vitals signs (oxygen saturation, heart rate, respiratory rate, blood pressure, temperature and electrocardiogram)and telephone control dairy (morning, evening)by the pulmonologist.<br>|
| No Intervention: home care<br>Early discharge from hospital with home care provided by hospital respiratory nurses and pulmonologists (daily visits). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time Until the First Exacerbation | Time until the first exacerbation is the time that patient is stable before a new exacerbation and meaning a good control of the disease. | Change from stable to exacerbation the first time at 6 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SATISFAD 10 | Instrument that evaluates satisfaction with home care services in a self-administered. The score ranges from 0 to 30, with the worst value being zero and the best value being 30. | Participants will be followed for the duration home care, an expected average of 7 days | 
| State-Trait Anxiety Inventory (STAI) | The structure of the scale resulting from the combination of item polarity dimensions and the original two factors (State and Trait Anxiety). Minimum value 0, maximum value 120. Lower score indicates higher anxiety. | Participants will be followed for the duration of home care, an expected average of 7 days | 
| Percentage of Participants With Medication Adherence Assessed Using Morinsky-Green-Levine Test | Consists of a series of 4 contrasting questions with answers dichotomous yes / no, reflecting the patient's behavior regarding compliance with medication. They are intended to assess whether the patient adopts correct attitudes regarding treatment for his illness; it is assumed that if attitudes they are incorrect the patient is non-compliant. | Participants will be followed for the duration of home care up 24 weeks | 
| Monitoring Compliance | It represents the compliance of the patients with respect to the sending of constants through the telemedicine monitor that should be (following the protocol) at least twice a day. The patient was considered compliant if he sent the constant at least 2 twice a day or non-compliant otherwise. | Participants will be followed for the duration of home care, an expected average of 7 days | 
| Number of Home Visits |  | Participants will be followed for the duration of home care, an expected average of 7 days | 
| COPD Assessment Test (CAT) | It's a simple questionnaire for assessing and monitoring COPD. It quantifies chronic obstructive pulmonary disease (COPD) impact in routine practice to aid health status assessment. It's self-administered in 2 min. It consists of 8 items that measure aspects of cough, expectoration, chest tightness, dyspnea, domestic activities, self-confidence, sleep and energy. Each section is scored from 0 to 5 and therefore a maximum of 40 points can be obtained; a higher score indicates a greater negative impact of COPD. Significant clinical changes correspond to a variation of 2 points or more. | Participants will be followed for the duration of home care and up to 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Telemonitoring, COPD, Home care