Study demonstrates feasibility, effectiveness of mobile care for COPD

A multimodal, digital community-based intervention was feasible and decreased illness-related distress in treating patients with chronic obstructive pulmonary disease (COPD), according to a study led by UMass Chan Medical School Program in Digital Medicine researchers.

Reports from the Healthy at Home study were published in Pilot and Feasibility Studies and BMC Digital Health.

A third study showing the program’s impact on hospitalization rates is under review to be published soon in another journal. The preprint study published online on medRxiv reported that patients with COPD who participated in Healthy at Home were less likely to be hospitalized, and had 61% decreased odds of readmission within 30 days of hospitalization, than similar patients who were not invited to participate in the study. Healthy at Home participants also displayed trends toward fewer emergency department visits and shorter hospital lengths of stay.

According to the U.S. Centers for Disease Control and Prevention, COPD is the third leading cause of death by chronic disease in the United States and the fifth most costly chronic disease.

“Even in our relatively small study, the fact that we found statistically significant findings of clinically relevant improvement associated with use of this technology was really an ‘Aha!’ moment for us,” said principal investigator Apurv Soni, MD, Ph.D.’21, assistant professor of medicine and co-director of the Program in Digital Medicine. “We did not anticipate that it would be this impactful. We just wanted to demonstrate proof of concept.”

John P. Broach, MD, MPH, MBA, associate professor of emergency medicine, and Laurel Caren O’Connor, MD’15, MSc’23, assistant professor of emergency medicine, are co-principal investigators on the study.

The study was conducted with virtual health care company Wellinks and CareEvolution health data platform.

Over 18 months, 100 patients with COPD who were at risk of requiring acute care within the next six months were enrolled in the pilot study. Almost all (96%) remained in the study for the six-month evaluation period.

Components of the program included: home-based mobile integrated health services; a physician-supervised team of paramedics available 24/7 to perform in-home medical care; a mobile integrated health dashboard that displays biometric data from wearable sensors, results of patient-reported outcomes and relevant clinical data from the electronic health record; and Wellinks’ virtual-first COPD management solution, which combines virtual pulmonary rehabilitation, personalized health coaching, monitoring through connected devices to measure spirometry and pulse oximetry, and an easy-to-use patient app.

Dr. Soni highlighted the importance of being able to integrate the Healthy at Home intervention with the clinical system. “One of the big pushes in digital medicine research, but also in clinical research overall, is how can we integrate clinical trials with the practice of medicine,” he said.

The early findings suggesting that patients were able to successfully adhere to the mobile interventions and experience a higher quality of life, with fewer hospitalizations and shorter stays for those who were hospitalized, impressed health system leaders to the extent that the program is now available for all eligible COPD patients at UMass Memorial Health as standard of care through its novel Digital Health Clinic.

Dr. O’Connor noted that Healthy at Home is one of the first clinical trials to integrate digital tools—including wearable devices and study apps—with on-the-ground home-based clinical services, facilitating comprehensive monitoring, detection, evaluation and treatment completely outside of brick-and-mortar health care facilities.

There are only 1,700 pulmonary rehabilitation centers across the country and 14 million patients with COPD who could be eligible, according to Soni. “If we line up everyone who is eligible for pulmonary rehab, it would take 100 years for them to get treatment,” he said. “And so, the idea of doing this through technology and home-based rehab is something we’re very excited about.”

Soni said his team was invited to apply for a large grant through the independent, nonprofit Patient Centered Outcomes Research Institute to conduct a nationwide clinical trial comparing in-person pulmonary rehab to telepulmonary rehab. Patients who participated in the Healthy at Home trial have been included in developing the design of the new study.

A multimodal, digital community-based intervention was feasible and decreased illness-related distress in treating patients with chronic obstructive pulmonary disease (COPD), according to a study led by UMass Chan Medical School Program in Digital Medicine researchers.

Reports from the Healthy at Home study were published in Pilot and Feasibility Studies and BMC Digital Health.

A third study showing the program’s impact on hospitalization rates is under review to be published soon in another journal. The preprint study published online on medRxiv reported that patients with COPD who participated in Healthy at Home were less likely to be hospitalized, and had 61% decreased odds of readmission within 30 days of hospitalization, than similar patients who were not invited to participate in the study. Healthy at Home participants also displayed trends toward fewer emergency department visits and shorter hospital lengths of stay.

According to the U.S. Centers for Disease Control and Prevention, COPD is the third leading cause of death by chronic disease in the United States and the fifth most costly chronic disease.

“Even in our relatively small study, the fact that we found statistically significant findings of clinically relevant improvement associated with use of this technology was really an ‘Aha!’ moment for us,” said principal investigator Apurv Soni, MD, Ph.D.’21, assistant professor of medicine and co-director of the Program in Digital Medicine. “We did not anticipate that it would be this impactful. We just wanted to demonstrate proof of concept.”

John P. Broach, MD, MPH, MBA, associate professor of emergency medicine, and Laurel Caren O’Connor, MD’15, MSc’23, assistant professor of emergency medicine, are co-principal investigators on the study.

The study was conducted with virtual health care company Wellinks and CareEvolution health data platform.

Over 18 months, 100 patients with COPD who were at risk of requiring acute care within the next six months were enrolled in the pilot study. Almost all (96%) remained in the study for the six-month evaluation period.

Components of the program included: home-based mobile integrated health services; a physician-supervised team of paramedics available 24/7 to perform in-home medical care; a mobile integrated health dashboard that displays biometric data from wearable sensors, results of patient-reported outcomes and relevant clinical data from the electronic health record; and Wellinks’ virtual-first COPD management solution, which combines virtual pulmonary rehabilitation, personalized health coaching, monitoring through connected devices to measure spirometry and pulse oximetry, and an easy-to-use patient app.

Dr. Soni highlighted the importance of being able to integrate the Healthy at Home intervention with the clinical system. “One of the big pushes in digital medicine research, but also in clinical research overall, is how can we integrate clinical trials with the practice of medicine,” he said.

The early findings suggesting that patients were able to successfully adhere to the mobile interventions and experience a higher quality of life, with fewer hospitalizations and shorter stays for those who were hospitalized, impressed health system leaders to the extent that the program is now available for all eligible COPD patients at UMass Memorial Health as standard of care through its novel Digital Health Clinic.

Dr. O’Connor noted that Healthy at Home is one of the first clinical trials to integrate digital tools—including wearable devices and study apps—with on-the-ground home-based clinical services, facilitating comprehensive monitoring, detection, evaluation and treatment completely outside of brick-and-mortar health care facilities.

There are only 1,700 pulmonary rehabilitation centers across the country and 14 million patients with COPD who could be eligible, according to Soni. “If we line up everyone who is eligible for pulmonary rehab, it would take 100 years for them to get treatment,” he said. “And so, the idea of doing this through technology and home-based rehab is something we’re very excited about.”

Soni said his team was invited to apply for a large grant through the independent, nonprofit Patient Centered Outcomes Research Institute to conduct a nationwide clinical trial comparing in-person pulmonary rehab to telepulmonary rehab. Patients who participated in the Healthy at Home trial have been included in developing the design of the new study.