Professor Song Yuanlin from Zhongshan Hospital, affiliated with Fudan University, together with multiple clinical centers, drew on chronic disease management experiences from France and published the results of a study titled "A Randomized Controlled Prospective Study of IoT-based Home Non-invasive Positive Pressure Ventilation for COPD Complicated with Chronic Respiratory Failure" in the eClinicalMedicine subjournal of The Lancet.
The study results suggest that after one year of intervention, patients in the IoT non-invasive ventilation management group showed improvements in health-related quality of life, including physical function, respiratory symptoms, comorbid symptoms, and sleep status, compared to patients in the conventional non-invasive ventilation group. Additionally, the study results indicated a longer time to acute exacerbation rehospitalization within one year for patients in the IoT group compared to the conventional group; the acute exacerbation rehospitalization rate for the IoT group was 34.3%, which was 21.7% lower than the 56.0% rate for the conventional group.
It is reported that this study is the world's first randomized controlled prospective study to apply IoT technology to manage patients with chronic obstructive pulmonary disease complicated by chronic respiratory failure using home non-invasive ventilation.
Research Illustration (excerpt from a paper)
The prevalence of chronic obstructive pulmonary disease (COPD) among people over 40 is 13.7%.
Against the backdrop of increasing challenges posed by chronic diseases to global public health, as early as 2016, China launched the "Healthy China 2030" plan, which clearly stipulated the goal of reducing the premature mortality rate from major chronic diseases by 30% by 2030 compared to 2015 in the field of "health services and guarantee".
Chronic diseases, also known as chronic non-communicable diseases, include conditions such as cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases. COPD is one of the significant challenges in chronic respiratory diseases.
COPD, a progressive and irreversible lung disease, currently affects approximately 100 million people in China, with around 10 million suffering from severe to extremely severe conditions. According to the Global Burden of Disease Study, COPD has become the fifth leading cause of death in China. The China Pulmonary Health (CPH) study shows that the prevalence of COPD among people over 20 in China is 8.6% (11.9% for males and 5.4% for females), while among those over 40, the prevalence is 13.7%.
Research by academician Wang Chen and others indicates that in China, COPD exacerbations occur 0.5-3.5 times per year, with the average hospitalization cost for acute exacerbations of COPD (AECOPD) patients in Beijing being 20,119 CNY in 2017.
"As the population ages, the prevalence and burden of COPD are expected to continue to rise," said Song Yuanlin, citing reasons such as inadequate primary healthcare services, tight medical insurance funds, and a large gap between medical supply and demand, making COPD screening and early detection in China face significant challenges.
Establishment of a Remote IoT Respiratory Chronic Disease Data Management Platform
Fortunately, in recent years, Chinese researchers have recognized the importance of digitization, technology, and data in empowering healthcare. For example, with the widespread application of new technologies such as the Internet, wearable devices, and artificial intelligence in the medical field, scientists are attempting a digital transformation of healthcare to achieve interconnectedness and remote management of medical services.
"This helps improve the efficiency and quality of medical services, achieve comprehensive management of healthcare, and systematically construct remote management intervention models and strategic combinations for chronic disease patients in the outpatient treatment stage oriented towards reducing costs and increasing efficiency in health services and precision prevention and control," said Song Yuanlin.
In reality, severe COPD patients, especially those with hypoxemia and hypercapnia, are more prone to recurrent exacerbations, requiring frequent hospitalizations and facing a higher risk of mortality, imposing a heavy burden on society.
Although there is already expert consensus on the in-hospital diagnosis and treatment of COPD patients with chronic hypercapnic respiratory failure, how to effectively and economically follow up with patients after discharge and manage their home-based continuity of care remains an urgent issue to be addressed.
To address this, the research team has established a remote IoT respiratory chronic disease data management platform, optimized discharge preparation and post-discharge follow-up, and collaborated with project partner VitalAire to develop remote monitoring and intervention methods for outpatient continuity of care compliance.
Researchers say this means implementing a rational and standardized combination of "health education + remote monitoring + timely intervention" for severe or extremely severe COPD patients in stable condition and undergoing home-based continuity of care. This approach has shown significant benefits in terms of relieving symptoms, improving quality of life, and reducing economic burden, whether in terms of relieving patients' symptoms, improving quality of life, or reducing economic burden.
Looking forward to more efforts to advance chronic disease management
Regarding the specific advantages of the remote IoT respiratory chronic disease data management platform, researchers say, firstly, remote treatment management based on the Internet of Things meets patients' basic treatment needs and greatly satisfies their psychological needs for attention and reassurance through health education and remote video sessions during management.
Secondly, this treatment approach achieves satisfactory therapeutic effects, meeting treatment expectations, not only improving quality of life but also extending the time to acute exacerbation readmission, reducing readmission rates, and providing dual guarantees in terms of physiology and psychology.
Finally, in terms of cost control, whether in direct costs such as medical costs or non-monetary costs such as time and mental costs, it has been minimized, and the corresponding medical insurance expenditures related to this disease will also decrease accordingly.
In addition to the above advantages, researchers say that by reducing unnecessary medical visits and waiting times, patients will also reduce the occurrence of medical disputes, alleviate the workload of hospital departments, and improve corresponding work efficiency.
Song Yuanlin said that this study combines domestic innovative digital chronic disease management technologies with the French experience in COPD patient discharge preparation and outpatient treatment management, providing personalized and systematic respiratory therapy services for patients in the experimental group after discharge. This research not only demonstrates the feasibility and clinical effectiveness of applying systematic remote management methods to outpatient management of COPD patients but also marks a new stage in the management of chronic obstructive pulmonary disease towards precise and intelligent healthcare and patient-centered care services.
"I hope that more innovative technologies and social forces will join this field and work together with clinical workers to promote the construction of a full-cycle management system for chronic disease patients from pre-hospitalization to hospitalization and post-hospitalization based on value-based healthcare, creating greater social value," said Song Yuanlin. Related paper information: https://doi.org/10.1016/j.eclinm.2024.102518
