Running head: HOME MONITORING SYSTEM AND EXACERBATION OF COPD
Evidenced Based Critically Appraised Topic
Laura Schultes, RN, MSN, DNP-s
University of Mary
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HOME MONITORING SYSTEM AND EXACERBATION OF COPD
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Case Presentation
Fifty-six year old C.M. presents to the clinic for a post-hospital examination. C.M. has
been hospitalized three times in the last year with acute exacerbation of COPD. C.M. was
diagnosed five years ago with COPD and continues to smoke. C.M. voices that she will exhibit
symptoms several weeks prior to being hospitalized, but is never sure if they are serious enough
to be seen or what to do to prevent the exacerbations. C.M. is inquiring if there is a way she
could call the clinic initially when symptoms worsen to help determine if she should be seen or
other recommendations that could help prevent another hospitalization.
Clinical Question in PICO Format
How does home monitoring compare to those that do not utilize home monitoring in
preventing acute exacerbations for COPD patients?
Scholarly Articles
Cruz, J., Brooks, D., & Marques, A. (2014). Home telemonitoring effectiveness in copd: a
systematic review. The International Journal of Clinical Practice, 68(3), 369-378.
Ding, H., Karunanithi, M., Kanagasingam, Y., Vignarajan, J., & Moodley, Y. (2014). A pilot
study of a mobile-phone-based home monitoring system to assist in remote interventions
in cases of acute exacerbation of copd. Journal of Telemedicine and Telecare, 20(3),
128-134.
Summary and Appraisal of Key Evidence
Article One
Evan’s hierarchy of evidence was used for the evaluation of the scholarly articles
(Spector, 2010). According to this evaluation tool, this article received a level of excellent since
it was a systematic review of the literature. The validity is strong as this was a systematic review
HOME MONITORING SYSTEM AND EXACERBATION OF COPD
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of the literature. The authors of this study performed an electronic literature search using
Medline, Embase, B-on and Web of Science between August 2012 and July 2013. Nine articles
were included after exclusion and inclusion criteria were examined. This study found a trend to
reduced healthcare costs in the telemonitoring group. Two of the articles showed a reduced
number of exacerbations and improved quality of life. The study concluded that although it
appears that home telemonitoring has a positive effect in reducing respiratory exacerbations,
hospitalizations and improving quality of life, the evidence is limited and further research is
needed. Strengths include the systematic nature of the review. Weakness or limitations include
the limited number of included articles. There are many opportunities that arise from this study
including the potential to decrease healthcare costs and improve quality of life for COPD
sufferers. The treats could include limited organizational resources to implement such a program
for all COPD patients and the lack of research in this area.
Article Two
This study, using Evan’s hierarchy of evidence, received a level of good (Spector, 2010).
The validity is good, although there was no randomization, which does leave room for bias.
There were eight participants in this study who used mobile phone to record observed COPD
symptoms including vital signs, shortness of breath, cough, heart rate, SpO2 and body
temperature. The data was stored in a remote server and allowed providers to view graphs to
show the variations of symptoms over time. The providers made daily calls and those with acute
exacerbations were treated at home. This study showed that major symptoms decreased
significantly after being treated at home and within two weeks the patients returned to baseline.
This study showed fewer hospital admissions, fewer emergency department visits and fewer
clinic visits within a six-month periods. The study concluded that there is potential for home
HOME MONITORING SYSTEM AND EXACERBATION OF COPD
monitoring of respiratory symptoms and early intervention of acute COPD exacerbations.
Strengths of this study were the significant results showing a potential for home monitoring of
COPD symptoms. Weakness or limitations include the small sample size and lack of
randomization. The opportunities for decreased healthcare costs were demonstrated in this
study. The threats include the ability to reproduce the findings in a different health care
organization.
Clinical Bottom Line
Both of the scholarly articles reviewed were of high quality, validity and showed a
benefit to using home monitoring for patients with COPD. With the current evidence reviewed
and the documented impact from COPD exacerbations, there appears to be more benefit than
risks associated with home monitoring and should be a recommendation for patients with
frequent acute exacerbations to help prevent recurrent hospitalizations.
Implications for Practice
Due to the severity and impact that COPD has on health care organizations, it is vital to
determine ways to increase health and decreased health care utilization. These two studies
demonstrate one of the ways this can be accomplished. Use of home monitoring for acute
exacerbations of COPD has the potential to help reduce health care costs by preventing hospital
readmissions, clinic visits and emergency department visits.
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HOME MONITORING SYSTEM AND EXACERBATION OF COPD
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References
Cruz, J., Brooks, D., & Marques, A. (2014). Home telemonitoring effectiveness in copd: a
systematic review. The International Journal of Clinical Practice, 68(3), 369-378.
Ding, H., Karunanithi, M., Kanagasingam, Y., Vignarajan, J., & Moodley, Y. (2014). A pilot
study of a mobile-phone-based home monitoring system to assist in remote interventions
in cases of acute exacerbation of copd. Journal of Telemedicine and Telecare, 20(3),
128-134.
Spector, N. (2010). Evidence-based nursing regulation: a challenge for regulators. Journal of
Nursing Regulation, 1(1), 30-36.