Automatic Event Detection in Lung Transplant Recipients Based on Home Monitoring of Spirometry and Symptoms

Abstract

Objective: The goal of this study was to develop, implement, and test an automated decision system to provide early detection of clinically important bronchopulmonary events in a population of lung transplant recipients following a home monitoring protocol. Subjects and Methods: Spirometry and other clinical data were collected daily at home by lung transplant recipients and transmitted weekly to the study data center. Decision rules were developed using wavelet analysis of declines in spirometry and increases in respiratory symptoms from a learning set of patient home data and validated with an independent patient set. Results: Using forced expiratory volume in 1 s or symptoms, the detection captured the majority of events (sensitivity, 80-90%) at an acceptable level of false alarms. On average, detections occurred 6.6-10.8 days earlier than the known event records. Conclusions: This approach is useful for early discovery of pulmonary events and has the potential to decrease the time required for humans to review large amount of home monitoring data to discover relatively infrequent but clinically important events.

Outcomes of telehealth care for lung transplant recipients

“…[12][13][14] A liver transplant program in Cincinnati OH is conducting a pilot study on the use of tablet-based real-time monitoring in the early post-operative period, including vital signs, glucose levels, weight, and contact with the healthcare team. [12][13][14] A liver transplant program in Cincinnati OH is conducting a pilot study on the use of tablet-based real-time monitoring in the early post-operative period, including vital signs, glucose levels, weight, and contact with the healthcare team.…”

“…This has been examined in prior studies and shown to be a feasible alternative to manual review to detect changes in pulmonary function. [12][13][14] A liver transplant program in Cincinnati OH is conducting a pilot study on the use of tablet-based real-time monitoring in the early post-operative period, including vital signs, glucose levels, weight, and contact with the healthcare team. 15 The use of these technologies may also facilitate data gathering for clinical outcome studies in transplant recipients and is something our program will be exploring in the near future.…”

Long-Term Follow-up of a Randomized Controlled Trial Evaluating a Mobile Health Intervention for Self-Management in Lung Transplant Recipients

“…Future mHealth interventions should take advantage of technologies that automate the process of data recording and tracking, such as electronic blood pressure cuffs and spirometers. Evidence from lung transplant recipients indicates that such features have high patient acceptability (27, 28). Moreover, mHealth interventions should refine their decision-support features so that patients can receive real-time feedback about all health data they record.…”

Using mobile health technology to deliver decision support for self-monitoring after lung transplantation

“…Although all LTR receive discharge instructions for detecting and reporting critical condition changes during home self-monitoring, LTR find it challenging to identify the thresholds of critical values for multiple health indicators, for example, the lower or upper limits of blood pressures, and to recognize critical changes from their own personal baselines [9]. Considering the amount of self-monitoring data generated by all LTR, it would be too time-consuming for clinicians to track and screen critical values for each LTR [10]. Patient engagement in self-management is important for the improvement of health outcomes [11,12].…”

“…Electronic spirometry systems have been reported to be reliable and valid for LTR health self-monitoring [10,13–15]. However, most electronic spirometry systems have been designed to send self-monitoring data to clinicians for interpretation, and do not provide decision support for LTR [15–19].…”