Sustained patient use and improved outcomes with digital transformation of a COPD service: RECEIVER trial and DYNAMIC-SCOT COVID-19 scale-up response

  1. A Taylor
  2. A Cushing
  3. M Dow
  4. J Anderson
  5. G McDowell
  6. S Lua
  7. M Manthe
  8. S Padmanabhan
  9. S Burns
  10. P McGinness
  11. DJ Lowe
  12. C Carlin

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Abstract

Introduction

LenusCOPD has been co-designed to enable digital transformation of COPD services for proactive preventative care. Patient-facing progressive web application, clinician dashboard and support website integrate patient-reported outcomes (PROs), self-management resources, structured clinical summary, wearable and home NIV data with asynchronous patient-clinician messaging. We commenced the implementation-effectiveness observational cohort RECEIVER trial in September 2019, with the primary endpoint of sustained patient usage and secondary endpoints including admissions, mortality, exacerbations, service workload and quality of life. We paused recruitment in March 2021 and provided LenusCOPD as routine care in the “DYNAMIC-SCOT” COVID-19 response service scale-up.

Methods

83 RECEIVER trial participants and 142 DYNAMIC-SCOT participants had completed minimum 1 year follow-up when we censored data on 31 st August 2021. We established a control cohort with 5 patients matched per RECEIVER participant from de-identified contemporary routine clinical data.

Results

Sustained patient app utilisation was noted in both cohorts. Median time to admission or death was 43 days in control, 338 days in RECEIVER and 400 days in DYNAMIC-SCOT participants who had had a respiratory-related admission in the preceding year. The 12-month risk of admission or death was 74% in control patients, 53% in RECEIVER and 47% in the DYNAMIC-SCOT sub-cohort participants. There was a median of 2.5 COPD exacerbations per patient per year with stable quality of life across follow up and a manageable workload for clinical users.

Conclusions

A high proportion of people continued to use the co-designed LenusCOPD application during extended follow-up. Outcome data supports scale-up of this digital service transformation.

Key messages

What is the key question?

Can sustained patient interaction and improved patient outcomes be achieved with digital transformation of a COPD service?

What is the bottom line?

Participants continue to use the LenusCOPD patient app, with an average of 3-3.5 interactions per person per week sustained >1-year post-onboarding. COPD- related hospital admissions and occupied bed days were reduced following LenusCOPD onboarding in participants with a history of a severe exacerbation in the previous year, with a median time to readmission of 380 days compared with 50 days in a contemporary matched control patient cohort.

Why read on?

Feasibility and utility results support scale-up adoption of these digital tools, to support optimised co-management of COPD and other long-term conditions within a continuous implementation-evaluation framework. This will establish a test-bed infrastructure for additional innovations including artificial intelligence-insights for MDT decision support.

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  1. ScreenIT

    SciScore for 10.1101/2022.04.04.22273427: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: All recruited participants provided written informed consent.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Inclusion criteria: >18 years of age; confirmed diagnosis of COPD (GOLD 2020)(7); a severe COPD exacerbation in the previous 12 months and/or chronic hypercapnic respiratory failure or sleep disordered breathing meeting established criteria for home NIV/CPAP treatment; personal or close contact with daily smartphone, tablet or desktop computer internet access to a web browser; able to give informed consent.
    GOLD
    suggested: (GOLD, RRID:SCR_000188)
    Statistical analyses were performed using R Studio version 4.0.5 and GraphPad Prism version 9.3.1, with significance assessed at the 0.05 level.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Whilst the lack of a randomised control arm is an important caveat, the control cohort derivation with an index date and outcome follow-up time period matched to RECEIVER participants reduces potential bias from seasonality and COVID-19 pandemic impacts on COPD event rates. Conclusions from this study have to be tempered by residual biases and confounders, including incomplete clinical information available for the control cohort and reduced integrity of matching for the control:DYNAMIC-SCOT comparison. Reduced event rates were seen in the control cohort across COVID-19 pandemic, this is in line with other investigations and suggests that this cohort is representative(26,27). The increased time to first events in the survival analyses and reduced median admission rates in the intervention cohorts provide a reassuring safety signal and encouraging hypothesis-generating utility data. The admission and community exacerbation event rates in the intervention cohorts provide further safety data: they are reduced when compared with historical NHS GG&C data, and similar to recent published data. It is therefore unlikely that reduced admission events in the intervention cohorts relate to delays from inappropriate community management, or that the intervention leads to unsupervised overuse of corticosteroid/antibiotic courses. The reduced median occupied bed day rate profiles in the intervention cohorts are particularly encouraging. COPD is estimated to consume €48.4 billion annually i...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04240353Active, not recruitingRECEIVER: Digital Service Model for Chronic Obstructive Pulm…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.04.04.22273427v1 on medRxiv