Design and implementation of a digital health home spirometry intervention for remote monitoring of lung transplant function

J Heart Lung Transplant. 2023 Feb 2:S1053-2498(23)00030-X. doi: 10.1016/j.healun.2023.01.010. Online ahead of print.

ABSTRACT

BACKGROUND: We developed an automated, chat-based, digital health intervention using Bluetooth-enabled home spirometers to monitor for complications of lung transplantation in a real-world application.

METHODS: A chat-based application prompted patients to perform home spirometry, enter their forced expiratory volume in 1 second (FEV₁), answer symptom queries, and provided patient education. The program alerted patients and providers to substantial FEV₁ decreases and concerning symptoms. Data was integrated into the electronic health record (EHR) system and dashboards were developed for program monitoring.

RESULT: Between May 2020 and December 2021, 544 patients were invited to enroll, of whom 427 were invited remotely and 117 were enrolled in-person. 371 (68%) participated by submitting ≥1 FEV₁ values. Overall engagement was high, with an average of 197 unique patients submitting FEV₁ data per month. In-person enrollees submitted an average of 4.6 FEV₁ values per month and responded to 55% of scheduled chats. Home and laboratory FEV₁ values correlated closely (rho = 0.93). There was an average of 133 ± 59 FEV₁ decline alerts and 59 ± 23 symptom alerts per month. 72% of patients accessed education modules, and the program had a high net promoter score (53) amongst users.

CONCLUSIONS: We demonstrate that a novel, automated, chat-based, and EHR-integrated home spirometry intervention is well accepted, generates reliable assessments of graft function, and can deliver automated feedback and education resulting in moderately-high adherence rates. We found that in-person onboarding yields better engagement and adherence. Future work will aim to demonstrate the impact of remote care monitoring on early detection of lung transplant complications.

PMID:37031033 | DOI:10.1016/j.healun.2023.01.010