Application Of Transitional Care Based On Mobile Medical App In Patients With Chronic Obstructive Pulmonary Disease

Objective(1)Based on "Internet+",we constructed and developed a mobile health application(mHealth APP)which centered on transitional care of chronic obstructive pulmonary disease(COPD),so as to achieve efficient management of discharge patients.(2)In order to improve patients self-management knowledge and skills,save medical resources,improve health outcomes and provide patients with individualized transitional care that span time and space,real-tine communication and dynamic management,we conducted a transitional care intervention based on mHealth APP.Methods(1)Literature review and experts consultation methods were used to construct the content of mHealth APP for COPD transitional care.Through multiple rounds of testing and correction by software engineers,researchers and users,Android/iOS system were developed,including the patient-version APP?the staff-version APP and database management.(2)From September 2017 to September 2018,114 patients with stable COPD were selected who discharged from the Department of Respiratory Medicine of FirstAffiliated Hospital of Guangxi Medical University.The patients were randomly divided into observation group and control group,57 cases each.The control group were given routine transitional care,and the observation group were given APP-based transitional care based on the control group intervention.Before,at the 3 and 6 months of the intervention,we used self-management scale,self-efficacy scale,CAT,Inhalation compliance scale and 6MWD to evaluate patients self-management,self-efficacy,quality of life,inhalation compliance and exercise tolerance.Compared two groups medical resource use:the numbers of re-admissions and acute exacerbations;clinical indicators:BMI,SPO2,FEV1%;patients evaluation and satisfaction with the use of APP at the 6-month interventionResults1.Patient-version APP included five modules:expert database,my messages,data upload,latest information and electronic medical record.Electronic medical record included file management,visit records,self-monitoring,follow-up records and satisfaction surveys.Staff-version APP included two modules:my to-do list and my patients.Background database management included user management,knowledge base management,dynamic monitoring and data export.2.There were no statistically significant difference in general data,self-management,self-efficacy,quality of life,6MWD,inhalation use compliance,the numbers of acute exacerbations and re-admission,clinical indicators between the two groups before the intervention(P>0.05).The baseline data were comparable.3.Application of transitional care intervention based on mHealth APP in patients with COPD3.1 Comparison of self-management:After the intervention,the total scores of self-management,daily life management,information management and self-efficacy were higher in the observation group than in the control group.The difference between the two groups was statistically significant difference(P<0.05).There was an interaction between the groups and time(P<0.05),and the time factor was statistically significant difference(P<0.05),the scores of observation group patients gradually increased with time.3.2 Comparison of self-efficacy:After the intervention,the total scores of self-efficacy,environnent and temperature,and safety behaviors were higher in the observation group than in the control group.The difference between the two groups was statistically significant difference(P<0.05).There was an interaction between the groups and time(P<0.05),and the time factor was statistically signifieant differenee(p<0.05),the scores of observation group patients gradually increased with time.After the intervention,the scores of physical activity were higher in the observation group than in the control group.The difference between the two groups was statistically significant difference(P<0.05).There was an interaction between the groups and time(P<0.05).3.3 Comparison of quality of life:After the intervention,the total scores of quality of life were lower in the observation group than in the control group.The difference between the two groups were statistically significant difference(P<0.05).There was an interaction between the groups and time(P<0.05).The time factor was statistically significant difference(P<0.05),the score of the observation group gradually decreased with time.3.4 Comparison of 6MWD:After the intervention,the 6MWD were higher in the observation group than in the control group.The difference between the two groups was statistically significant difference(P<0.05).There was an interaction between the groups and time(P<0.05).The time factor was statistically significant difference(P<0.05),the 6MYVD of the observation group gradually increased with time.3.5 Comparison of inhalation compliance:There was no statistically significant difference in inhalation compliance between the two groups at 3 months of intervention(P>0.05).There was statistically significant difference between the two groups at 6 months(P<0.05).3.6 Comparison of clinical indicators:There were significant differences in BMI and SPO2 between the two groups at 6 months(P<0.05).The observation group was better than the control group.There was no significant difference in FEV1%between the two groups(P<0.05).3.7 Comparison of utilization of health resources:There were statistically significant difference in the number of re-admissions and acute exacerbations between the two groups(P<0.05).The observation group were lower than those in the control group at 6 months after intervention.4.To investigate COPD patients' evaluation and satisfaction of using APPThe overall evaluation and satisfaction scores of patients with COPD on the APP was(4.60±0.82)points,and the scores in the top three were:information content practical,medical staff service and nursing guidance targeted,respectively(4.65±0.79)points,(4.60± 0.70)points,(4.46 ± 0.66)points.Conclusions MHealth APP that we developed in this study could be well applied to patients with COPD,with high evaluation and satisfaction.The transitional care intervention based on mHealth APP has improved patients with COPD self-management,self-efficacy,quality of life,exercise endurance and inhalant use compliance.lt also saved medical resources and improved health outcomes.Transitional care of COPD based on mHealth APP was worthy for further clinical application,but its long-term and large sample effects need further study to test.