1. A Managed Home Telehealth Service
for Severe COPD Patients in Spain
Ofer Atzmon, B.Sc., VP Business Development and
Marketing1, Cristina Gómez Suárez, PhD2, Business
Development Manager, Europe
1Aerotel Medical Systems, Holon, Israel, 2Linde Healthcare, Madrid, Spain.
ePoster
ATA Annual Meeting, Austin, Texas, May 2013

2. Introduction and Objectives
• A new service for monitoring of severe Chronic Obstructive
Pulmonary Disease (COPD) patients at home using telehealth
technology was introduced by Linde Healthcare in Spain.
• A study was conducted in order to establish the efficacy of the
service, measured as the reduction in (a) the number of
hospitalizations; (b) the length of hospital stays; and (c)
number of Accident & Emergency (A&E) visits, due to COPD
exacerbations.
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3. Materials and Methods (1)
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• The study was a randomized controlled trial including two groups, a
group receiving conventional care and another home telehealth, with 30
patients in each.
• The trial was performed by the Pneumology Department from the
Hospital Universitario La Princesa (Madrid, Spain) and coordinated with
four local Primary Care Centers (Goya, Montesa, Lagasca y Castelló).
• Telehealth equipment and software was provided by Aerotel Medical
Systems (Holon, Israel).
• Home service, technical assistance and specialized telehealth clinical call
center (CCC) was provided by Linde Healthcare (Madrid, Spain).
• Patients included in the trial suffered severe COPD (GOLD stage IV) and
where on home oxygen therapy.
• Additionally, they had experienced at least an exacerbation episode that
leaded to hospitalization in the year prior to inclusion in the trial.

4. Materials and Methods (2)
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• Vital signs like blood pressure, heart rate, blood oxygen saturation
where monitored on a daily basis and peak-flow weekly. Monitored data
was received, and the CCC performed daily follow-up and triage (fig. 1).
• Emphasis was made on designing an intuitive and easy to use system, as
well as on adequate preparations and training of both patients and
caregivers prior to the start of the service.
• The clinical response was the result of a coordinated effort between the
various stakeholders, with a “traffic light” like triage system being used
(fig. 2).
• The CCC resolved all non-adherence and technical issues, and clinical
alerts activated by any alterations out of range after these baseline
values had been verified with a clinical questionnaire.
• When confirmed, clinical alerts were escalated to the clinical responsible
who initiated an immediate evaluation and response.

5. Materials and Methods (3)
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Fig. 1: Telehealth Service Platform

6. Results (1)
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• All of the patients included in the trial where polymedicated and suffered
from different comorbidities (table 1).
• Among the home telehealth group, 21 patients reported to have a caregiver
with a moderate average care burden (Zarit test average score of 48.08).
• The number of A&E visits, hospital admissions, length of stay, ICU
admissions and exits were registered for both conventional care and home
telehealth groups during a period of 7 months (fig. 3).
• The clinical response pathway after evaluation of clinical alerts upon
severity (fig. 4) was either:
– a telephone recommendation or a home care visit by the clinical
responsible for mild severity, and a priority appointment at the
respiratory department, or
– suggestion for A&E visit for very severe alerts
• The acceptance of the home telehealth service was high among the
patients, with an average score of 8.95 in a scale of 10.

7. Results (2)
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Fig 3: Hospital resources usage for both Home Telehealth
and Conventional Care groups.

8. Results (3)
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Table 1: Clinical characteristics at baseline
Parameter Home
Telehealth
Conventional
Care
p-value
FEV1 37.76 37.1 0.46
BODEX 5.43 5.63 0.20
CAT 17.69 17.32 0.85
Previous hospitalizations
(COPD exacerbation)
1.72 1.80 0.59
Respiratory acidosis 0.17 0.1 0.108
100% stage D according to GOLD 2011: severe patients with comorbidities
Fig 4: Clinical response pathway

9. Conclusions
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• The Home Telehealth group did considerably reduce the
number of A&E visits (p 0.001), the number of hospital
admissions (p 0.015) and the length of hospital stay (p 0.018)
as compared with the Control Group.
• Home Telehealth Services are effective in the follow-up of
patients with severe COPD, optimizing care and associated
costs, and starting care at the patient’s home when possible.
• Patients adapted well to the telehealth service, were highly
satisfied with the service and no withdrawals were observed
due to difficulty in the use of the telehealth equipment.