IMPACT OF TELEMEDICINE ON HEALTH CARE UTILIZATION IN PATIENTS WITH ADVANCED CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Abstract

Chest. 2009;136(4_MeetingAbstracts):92S. doi:10.1378/chest.136.4_MeetingAbstracts.92S-a FREE TO VIEW PURPOSE: Exacerbations of chronic obstructive pulmonary disease (COPD) were responsible for nearly 10 million urgent visits in 2000 and cost an estimated $16 billion in the United States each year. Telemedicine, introduced to help manage chronic diseases, has been shown to reduce healthcare utilization in diabetes, congestive heart failure and psychiatric disorders. Less is known about its utility in COPD management. METHODS: In this retrospective analysis of the COPD telemedicine program at Overton Brooks Veteran's Administration Medical Center, we compared the year prior to enrollment to the first year on the intervention among the first 100 enrollees. All subjects had advanced COPD. Significant COPD exacerbations were defined by unscheduled hospital visits with a primary diagnosis of COPD. The intervention, the iCare Health Buddy device, is an in-home electronic device that requests information on a participant's health, and responses are transmitted to a registered nurse; subsequent interventions were at the discretion of practitioners. Comparisons were made using signed rank tests. RESULTS: Among all patients studied, there tended to be fewer significant COPD exacerbations during the intervention period compared to the year prior (mean reduction: 0.14 visits per year, relative reduction: 14.6%, p = 0.18). Among the 22 participants with at least 2 exacerbations in the pre-enrollment period, there was a reduction in significant COPD exacerbations; unscheduled hospital visits for COPD fell from an average of 3.59 visits/year to 1.95 visits/year (46% relative reduction, p = 0.003). CONCLUSION: Enrollment in this particular telemedicine program was associated with a reduction in unscheduled healthcare utilization for COPD, especially among those who had previously experienced frequent COPD exacerbations. CLINICAL IMPLICATIONS: Our experience would suggest that automated telemedicine programs are useful in the management of advanced COPD and may reduce the cost, both personal and monetary, of this disease. DISCLOSURE: Toby Smith, No Financial Disclosure Information; No Product/Research Disclosure Information