Technology-enabled remote monitoring for chronic obstructive pulmonary disease (COPD)

Background

Timely identification of patients at risk of deterioration is crucial to its successful management, as is access to pulmonary rehabilitation (education and physical exercise programmes) and self-management tools (helping patients understand and track their symptoms and disease progression; supporting behaviour change and medication adherence). Technology-enabled remote monitoring, such as using devices to monitor a patient's health (e.g. oxygen saturation or inhaler adherence) and digital applications to record patient clinical data in their own home and share it electronically with a health professional, is one of the potential means to support patients in managing COPD and to improve their experience of care and outcomes.
  

What is the issue? 

Current examples of technology-enabled remote monitoring in the COPD care pathway range from the use of smart inhalers to apps digitally facilitating virtual pulmonary rehabilitation to dedicated care hubs (staffed by a health professional) providing 24-hour proactive remote monitoring. However, despite the potential of technology-enabled remote monitoring in COPD management, key gaps remain in the evidence on how to effectively implement COPD care pathways that are enabled by technology. It is also not fully known what approaches work in which contexts and for whom; what the implications are for patients, carers and the health workforce; and how to ensure that the approaches help with addressing inequalities and do not exacerbate them. 

There is widespread interest in technology-enabled remote monitoring for COPD, demonstrated by a diverse and quickly evolving landscape of healthcare and technology providers and pilot, testing, and implementation projects in the UK. Such examples of implementation offer valuable insights into real-world applications of technology-enabled service provision for patients with COPD, its impact and how such technology may become more systematically and effectively embedded within respiratory care pathways. 

How are we helping? 

DECIDE (Digitally Enabled Care in Diverse Environments) is a new centre for rapid evaluation of technology-enabled remote monitoring in health and care, funded by the National Institute for Health and Care Research, Health and Social Care Delivery Research (NIHR HSDR). DECIDE is a partnership between the University of Oxford and RAND Europe. 

The DECIDE centre will conduct a rapid evaluation to inform decision-making around technology-enabled remote monitoring for COPD and planning for winter pressures, in line with the strategic priorities of the NHSE LungHealth@Home team – the policy customer for this work. The aim of this evaluation is to gain a deeper understanding of technology-enabled remote monitoring of patients living with COPD, and generate transferable lessons on the resources, systems, people, interactions, roles, behaviours and structures needed to achieve sustained adoption at scale. This evaluation will provide novel insights to inform implementation decisions focused on adoption, adaption and spread of technology-enabled remote monitoring for COPD. We hope that the findings will be helpful for informing policy decisions at a national level, support local system improvement and implementation, as well as be of wider interest to charities, diverse populations and scholars from a wide range of disciplines. 

The evaluation will unfold in two core phases and include the following key approaches: 

• Case studies to learn from efforts taking place and to inform NHS winter planning. We will learn from four case studies based on document review and stakeholder consultation (interviews) to understand how, where, and by whom technology-enabled remote monitoring is used, discern lessons for implementation and potential rapid take up in the context of winter planning and beyond.  

• Development of user-friendly resources to help with efforts to implement, spread and scale technology-enabled remote monitoring services for patients with COPD. Building on the case studies, literature review, and workshops with health care experts and service users and/or carers, we will co-design resources to support set up, access to and/or use of technology-enabled remote monitoring in the context of COPD care pathways.