Abstract
Background: The COPD Virtual Care at Home study provides digital health tools to patients who would otherwise been admitted to hospital so that they can be treated with clinician led care at home.
Approach: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease, which is characterised by airflow limitation that is not fully reversible. The impact of COPD on healthcare facilities is profound, but it also has wider social and economic effects. Virtual Care at Home could potentially alleviate some of this burden. The ability to discharge patients in a safe manner to the community will improve access to acute hospital beds and reduce overall length of stay (LOS). We provided the patients with a kit containing a suite of home health devices (pulse oximeter, blood pressure monitor) synced via Bluetooth to a tablet. Through an approved remote patient monitoring system(RPMS) Mypatientspace, the patients take their measurements twice daily which are reviewed by the clinical care team. Prior to development of this care pathway we involved patient focus groups, respiratory clinical staff, the health psychology department, the Hospital Ethics Board, device and software vendors, statisticians, Hospital and Community Management. While the clinical outcomes are very important in this study, we wanted to explore what was the patient experience was during their virtual care at home stay. With the help of the Health Psychology Department, we chose two patient satisfaction surveys, the PSQ-18 (modified for virtual care) and the mHealth App Usability Questionnaire (MAUQ). These questionnaires were in bedded into the RPMS to allow for easy access for the patients upon discharge. The primary outcomes of app usability score (out of 147) and overall patient satisfaction score (out of 100) were compared across seven demographic and clinical factors - age, sex, smoking status, support status, number of admissions in the past 12 months, number of exacerbation in the past 12 months, LOS.
Results: The data was collected from 16 (12 female, 4 male) individuals (2 of which were readmitted to the ward 2 and 4 times giving multiple responses). All patient data was analysed with the statistical software R v4.4 [R Core Team (2024)]. For the provisional sample size (𝑛=20), each of these was included in a separate linear regression model. Mean age of 74.2 years with an average length of stay of 8.2. The average patient satisfaction on visual analogue scale and usability score was 94/100 and 120.95/147 respectively. Significant positive association was observed between LOS and usability (p<0.001) and lower satisfaction with male patients compared to females (p<0.001). A trend of positive association was observed that living with a partner/children is positively associated with usability (p=0.066) and satisfaction (p=0.051).
Implications: These provisional results show that the virtual hospital care at home model is very acceptable to patients and that age is not a significant factor in usability of technology but living with a partner/children may improve it. Going forward we will continue to recruit patients to analyse their experience on the virtual care at home ward.