title: Outcomes of a telemonitoring-based program (telEPOC) in frequently hospitalized COPD patients.
abstract: BACKGROUND
  The increasing prevalence of chronic diseases requires changes in health care delivery. In COPD, telemedicine appears to be a useful tool. Our objective was to evaluate the efficacy (in improving health care-resource use and clinical outcomes) of a telemonitoring-based program (telEPOC) in COPD patients with frequent hospitalizations.
  
  
  METHODS
  We conducted a nonrandomized observational study in an intervention cohort of 119 patients (Galdakao-Usansolo Hospital) and a control cohort of 78 patients (Cruces Hospital), followed up for 2 years (ClinicalTrials.gov identifier: NCT02528370). The inclusion criteria were two or more hospital admissions in the previous year or three or more admissions in the previous 2 years. The intervention group received telemonitoring plus education and controls usual care.
  
  
  RESULTS
  Most participants were men (13% women), and the sample had a mean age of 70 years, forced expiratory volume in 1 second of 45%, Charlson comorbidity index score of 3.5, and BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index score of 4.1. In multivariate analysis, the intervention was independently related to lower rates of hospital admission (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.27-0.54;P<0.0001), emergency department attendance (OR 0.56, 95% CI 0.35-0.92;P<0.02), and 30-day readmission (OR 0.46, 95% CI 0.29-0.74;P<0.001), as well as cumulative length of stay (OR 0.58, 95% CI 0.46-0.73;P<0.0001). The intervention was independently related to changes in several clinical variables during the 2-year follow-up.
  
  
  CONCLUSIONS
  An intervention including telemonitoring and education was able to reduce the health care-resource use and stabilize the clinical condition of frequently admitted COPD patients.
authors.affiliation: Pneumology Department, Galdakao-Usansolo Hospital, Galdakao; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao.
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Esteban
authors.affiliation: Pneumology Department, Galdakao-Usansolo Hospital, Galdakao.
authors.forename: Javier
authors.initials: J
authors.lastname: Moraza
authors.affiliation: Pneumology Department, Cruces Hospital, Barakaldo.
authors.forename: Milagros
authors.initials: M
authors.lastname: Iriberri
authors.affiliation: Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao; Research Unit, Galdakao-Usansolo Hospital, Galdakao.
authors.forename: Urko
authors.initials: U
authors.lastname: Aguirre
authors.affiliation: Primary Care Unit, Barrualde Integrated Healthcare Organisation (OSI-Barrualde), Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Goiria
authors.affiliation: Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao; Research Unit, Galdakao-Usansolo Hospital, Galdakao.
authors.forename: José M
authors.initials: JM
authors.lastname: Quintana
authors.affiliation: Pneumology Department, Galdakao-Usansolo Hospital, Galdakao.
authors.forename: Myriam
authors.initials: M
authors.lastname: Aburto
authors.affiliation: Pneumology Department, Galdakao-Usansolo Hospital, Galdakao.
authors.forename: Alberto
authors.initials: A
authors.lastname: Capelastegui
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D019033:Delivery of Health Care, Integrated; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D007722:Health Knowledge, Attitudes, Practice; D006295:Health Resources / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D015999:Multivariate Analysis; D016017:Odds Ratio; D010353:Patient Education as Topic; D010359:Patient Readmission; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D058998:Remote Sensing Technology; D012307:Risk Factors; D000068997:Smartphone; D013030:Spain; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods; D013686:Telemetry; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity
keywords: COPD; hospitalizations; telemonitoring program