Telemonitoring COPD patients with frequent hospitalisations

COPD is a leading cause of morbidity and mortality worldwide with two important impact points; one is the use of healthcare resources that the disease implies; and the other, the effect of the disease in the patient. Hospitalization has been identified from years as the main factor of cost in this disease. At the same time exacerbation, especially hospitalization, has potential severe consequences in the COPD patient as lost of pulmonary function and quality of life and increase in mortality risk.
The project has the following objectives:
1. Determine the rate of readmission for exacerbation in a cohort of patients with COPD with readmissions to the hospital, comparing with themselves in the previous 2 years and during the same period of intervention, with respect to an external control group.
2. Determine the frequency of this cohort of patients with COPD who are readmitted to hospital emergency departments compared to a control group.
3. Evaluate the quality of life related to health during follow-up period compared to a control group.
4. Evaluate the degree of satisfaction of patients in both cohorts.
5. Establish medical costs arising from the implementation of this program about a group treated by conventional care and respect to the costs prior to the inclusion of this program.
The inclusion criteria were being hospital admitted at least twice in the previous year or at least three times in the 2 previous years. The cohorts were follow-up for 2 years. Several clinical measurements like pulmonary function, exercise capacity, health related quality of life, limitation in daily life activities and anxiety and depression were recorded in both cohorts. Telemonitoring and an organized education program were only and applied in the intervention cohort.
Finally, the key aspects that can be transferable are the education program and the program of telemonitoting and control of the patients.

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Policy Priorities
Better data to promote research, disease prevention and personalised health and care
General practitioners, Hospitals, Housing organisations, Informal caregivers, Nurses, Primary care centres, Regional public authorities, Specialised physicians
Geographical Scope
Regional level
Total Budget
€100,000 – €499,999
Available upon request
People reached
250 – 999