Validation of ACCESS: an automated tool to support self-management of COPD exacerbations

• Published in: International journal of chronic obstructive pulmonary disease Vol. 13; pp. 3255 - 3267
• Main Authors: Boer, Lonneke M, van der Heijden, Maarten, van Kuijk, Nathalie Me, Lucas, Peter Jf, Vercoulen, Jan H, Assendelft, Willem Jj, Bischoff, Erik W, Schermer, Tjard R
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2018; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Automation; Body temperature; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Computer-Assisted Instruction - methods; COPD; Decision Support Techniques; Development and progression; Diaries; Empowerment; exacerbations; Female; Forced Expiratory Volume; Humans; Male; Medical research; Middle Aged; Netherlands; Observational Studies as Topic; Original Research; Outpatient care facilities; Oximetry - methods; Oxygen saturation; Patients; Program Evaluation; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary Disease, Chronic Obstructive - therapy; Rehabilitation; Respiratory symptoms; self-management; Self-Management - methods; Self-Management - psychology; Software; software application; Symptom Assessment - methods; Symptom Flare Up; Technology application; telehealth; treatment advice; Values; Netherlands; automated device; diagnostic accuracy; treatment advice; mobile health; exacerbations; telehealth; health; software application; self-management; COPD
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S167272

To support patients with COPD in their self-management of symptom worsening, we developed Adaptive Computerized COPD Exacerbation Self-management Support (ACCESS), an innovative software application that provides automated treatment advice without the interference of a health care professional. Exacerbation detection is based on 12 symptom-related yes-or-no questions and the measurement of peripheral capillary oxygen saturation (SpO ), forced expiratory volume in one second (FEV ), and body temperature. Automated treatment advice is based on a decision model built by clinical expert panel opinion and Bayesian network modeling. The current paper describes the validity of ACCESS. We performed secondary analyses on data from a 3-month prospective observational study in which patients with COPD registered respiratory symptoms daily on diary cards and measured SpO , FEV , and body temperature. We examined the validity of the most important treatment advice of ACCESS, ie, to contact the health care professional, against symptom- and event-based exacerbations. Fifty-four patients completed 2,928 diary cards. One or more of the different pieces of ACCESS advice were provided in 71.7% of all cases. We identified 115 symptom-based exacerbations. Cross-tabulation showed a sensitivity of 97.4% (95% CI 92.0-99.3), specificity of 65.6% (95% CI 63.5-67.6), and positive and negative predictive value of 13.4% (95% CI 11.2-15.9) and 99.8% (95% CI 99.3-99.9), respectively, for ACCESS' advice to contact a health care professional in case of an exacerbation. In many cases (71.7%), ACCESS gave at least one self-management advice to lower symptom burden, showing that ACCES provides self-management support for both day-to-day symptom variations and exacerbations. High sensitivity shows that if there is an exacerbation, ACCESS will advise patients to contact a health care professional. The high negative predictive value leads us to conclude that when ACCES does not provide the advice to contact a health care professional, the risk of an exacerbation is very low. Thus, ACCESS can safely be used in patients with COPD to support self-management in case of an exacerbation.