Validity of an automated telephonic system to assess COPD exacerbation rates

Abstract

Current tools for recording chronic obstructive pulmonary disease (COPD) exacerbations are limited and often lack validity testing. We assessed the validity of an automated telephonic exacerbation assessment system (TEXAS) and compared its outcomes with existing tools.Over 12 months, 86 COPD patients (22.1% females; mean age 66.5 yrs; mean postbronchodilator forced expiratory volume in 1 s 53.4% predicted) were called once every 2 weeks by TEXAS to record changes in respiratory symptoms, unscheduled healthcare utilisation and use of respiratory medication. The responses to TEXAS were validated against exacerbation-related information collected by observations made by trained research assistants during home visits. No care assistance was provided in any way. Diagnostic test characteristics were estimated using commonly used definitions of exacerbation. Detection rates, compliance and patient preference were assessed, and compared with paper diary cards and medical record review.A total of 1,824 successful calls were recorded, of which 292 were verified by home visits (median four calls per patient, interquartile range three to five calls per patient). Independent of the exacerbation definition used, validity was high, with sensitivities and specificities between 66% and 98%. Detection rates and compliance differed extensively between the different tools, but were highest with TEXAS. Patient preference did not differ.TEXAS is a valid tool to assess COPD exacerbation rates in prospective clinical studies. Using different tools to record exacerbations strongly affects exacerbation occurrence rates.

'Exacerbation-free time' to assess the impact of exacerbations in patients with chronic obstructive pulmonary disease (COPD): a prospective observational study

“…Although this may account for some of the discrepancy in the time spent in exacerbations, our previous study demonstrated TEXAS to be a valid measure to assess exacerbation frequency. 21 Our mean exacerbation frequency does correspond with the findings of Erdal et al, 22 who found a median exacerbation frequency of four in their hospital-recruited COPD patients.…”

Features of a Mobile Support App for Patients With Chronic Obstructive Pulmonary Disease: Literature Review and Current Applications

“…Results did not show any reduction in hospital admissions or improvement in quality of life [12]. However, there have been some tools such as TEXAS and EXACT to quantify and measure exacerbations in patients with COPD patients [15,16]. The validity of TEXAS, an automated telephonic exacerbation assessment system which records symptoms and use of medication, has been assessed.…”

“…The study was carried out on 86 patients with COPD. The results showed that TEXAS, when compared with other tools such as a paper diary or medical record review, showed the highest detected rates of exacerbations and patients’ compliance in providing exacerbation-related information [16]. The EXACT daily diary was designed to standardize the process for assessing acute exacerbations of patients with COPD by providing a direct measure of patient-reported symptoms of exacerbation [15].…”

A comparison of three multidimensional indices of COPD severity as predictors of future exacerbations

“…Walters et al24 investigated diary-keeping in COPD and ascertained the items that best predicted emergency attendances for exacerbations. They conclude that good compliance can be achieved using daily diaries in COPD, although this is worse in those with poor educational level, whereas Bischoff et al25 report that an automated telephonic exacerbation assessment system is a valid tool to assess COPD exacerbation rate in prospective clinical study. In this study, we not only used diaries but also systematically asked patients every month to minimize recall bias.…”