Use of Remote Cardiorespiratory Monitoring is Associated with a Reduction in Hospitalizations for Subjects with COPD

Figures & data

Figure 1 The sensors included in the RPM service are adhered to undergarments to address the burden involved in maintaining a clip-on or wrist-worn sensor, without requiring skin-adhesion.

Figure 2 The hub passively captures sensor data and securely transmits it to the cloud. It provides limited feedback to patients.

Table 1 The Risk Assessment Script

1	These past two days, are you more short of breath than usual?
2	These past two days, are you having more sputum than usual?
3	These past two days, have you noticed any changes in the color of your sputum?
4	Do you have any new concerns about your breathing?
5	Would you like me to make an appointment with your doctor?

Notes: The risk assessment is administered to patients by clinicians, post-notification of physiologic deviations. Patients who reported ‘Yes’ to any of the questions were escalated to their provider.

Table 2 Baseline Characteristics of Subjects

Parameter	Value
Age, years, mean (SD)	73.8 (9.3)
Females, n (%)	72 (57.1%)
Body mass index, kg/m2, mean (SD)	28.2 (7.5)
FEV1 (within 5y), % predicted (post-bronchodilator when available), mean (SD)	59.5 (21.3)^a
Supplemental oxygen use, n (%)	59 (46.8%)
Active smoker, n (%)	27 (21.4%)
Depression, n (%)	35 (28.0%)
African American, n (%)	28 (23.7%)^b
Comorbidities:
Atrial fibrillation, n (%)	22 (17.5%)
Congestive heart failure, n (%)	24 (19.0%)
Hypertension, n (%)	85 (67.5%)
Diabetes, n (%)	43 (34.1%)
Sleep apnea, n (%)	51 (40.5%)
Stroke or cerebrovascular accident, n (%)	15 (11.9%)
Interstitial Lung Disease (ILD), n (%)	2 (1.6%)
History of any cancer, n (%)	36 (28.6%)
Thyroid disease, n (%)	21 (16.7%)
Coronary artery disease, n (%)	27 (21.4%)

Notes: ^aN=109. ^bN=118.

Table 3 Differences in Healthcare Utilization per Patient Pre- and Post-Initiation of RPM

Parameter	Pre-Initiation	Post-Initiation	Percent Change	P-value
Hospitalizations (all-cause)	1.09 ± 0.07	0.38 ± 0.06	−65.0% ± 8.9%	<0.001
Hospitalizations (all-cause) length of stay	5.77 ± 0.86^a	5.00 ± 1.8^b	−13.3% ± 25.3%	0.612
Hospitalizations (cardiopulmonary)	0.70 ± 0.08	0.25 ± 0.05	−63.6% ± 13.1%	<0.001
Hospitalizations (cardiopulmonary) length of stay	6.74 ± 1.40^c	5.46 ± 1.63^d	−19.0% ± 29.6%	0.097
ER visits (all-cause)	0.48 ± 0.07	0.27 ± 0.09	−44.3% ± 24.4%	<0.001
ER visits (cardiopulmonary)	0.29 ± 0.05	0.16 ± 0.06	−44.4% ± 27.4%	0.002
Pulmonary outpatient visits	4.22 ± 0.24	4.78 ± 0.28	13.2% ± 8.7%	0.038
Prescribed steroid courses	0.92 ± 0.13	0.95 ± 0.14	3.4% ± 20.3%	0.589

Notes: Data are presented as mean ± SE. The ± values for percent change are derived from the standard error of differences between the pre- and post-initiation groups. ^aN=78. ^bN=34. ^cN=57. ^dN=24.

Figure 3 Healthcare resource utilization outcomes pre- to post-initiation of RPM. Each bar is labeled with the absolute number of events.

Table 4 Descriptive Statistics of Hospitalizations, All-Cause and Cardiopulmonary

Parameter	Pre-Initiation	Post-Initiation	P-value
All-cause hospitalizations			<0.001
Mean ± SD	1.09 ± 0.07	0.38 ± 0.06
Median (25%, 75%)	1 (1, 1)	0 (0, 1)
Range	0–5	0–3
Total Occurrences	137	48
Cardiopulmonary hospitalizations			<0.001
Mean ± SD	0.70 ± 0.08	0.25 ± 0.05
Median (25%, 75%)	1 (0, 1)	0 (0, 0)
Range	0–5	0–3
Total Occurrences	88	32

Figure 4 Sankey graph where colored bins on the left represent groups of patients who experienced 0, 1, 2, or 3+ all-cause hospitalizations pre-initiation of RPM. The ribbons represent the flow of those patients to a bin representing the number of hospitalizations they experienced in the 12 months post-initiation. The numbers indicate numbers of patients in that subgroup.

Figure 5 The mean RPM adherence values of the individual participants in the cohort across all months post-initiation of RPM.

Figure 6 Boxplots showing the distribution of adherence rates to RPM for each month post-initiation. For each month, adherence is calculated as the proportion of days in which sensors were worn ≥8 hours.