A Home Telemonitoring Program Reduced Exacerbation and Healthcare Utilization Rates in COPD Patients with Frequent Exacerbations

Rationale: As the impact of home telemonitoring on patients with chronic obstructive pulmonary disease (COPD) is not fully understood and reduction in healthcare utilization is not proven, we attempt to evaluate the effects of home telemonitoring on healthcare utilization in patients with COPD. Subjects and Methods: We conducted a retrospective cohort study using the Veterans Health Administration database of COPD patients enrolled in the Care Coordination Home Telehealth (CCHT) program. We evaluated the effects of monitoring through this program in patients with moderate to severe COPD and frequent exacerbations. Numbers of emergency department (ED) visits, urgent care (UC) visits, and hospitalizations were all evaluated before and after enrollment. The differences in average pre-enrollment and during-enrollment numbers of hospital admissions, ED/UC visits, and exacerbations were tested for significance among all patients enrolled in the program who had one or more exacerbations at pre-enrollment; results were expressed on a per-year basis. Results: Data were available on a total of 1,133 patients with COPD enrolled in the CCHT program between 2005 and 2009. Given the objectives of our study, we only included 369 patients who had at least one exacerbation per year in the year prior to enrollment. Of these, 71.5% had a reduction in numbers of ED visits and exacerbations requiring hospitalizations after enrollment in the program. The average number of hospital admissions, ED visits, and total exacerbations were all reduced (0.41 +/- 1.68, 0.15 +/- 1.65, and 0.56 +/- 2.3, respectively; all with p < 0.01). The pre-enrollment number of exacerbations was the only factor observed to be significantly associated with the reduction in number of exacerbations. Conclusions: In patients with COPD and frequent exacerbations, enrollment in a home telemonitoring program may decrease healthcare utilization.