A Retrospective Analysis of Alerts Generated From Home Spirometry and Oximetry Measurements in a Real-world Multicentre Home Monitoring Programme for Patients With Interstitial Lung Disease

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Abstract Rationale: In-person clinic review and laboratory-based physiological measurements place significant burden on patients with interstitial lung disease (ILD) due to exertional breathlessness, oxygen dependency, infection risk, work and carer commitments. Long-term home monitoring offers an alternative approach and remote clinician review may enable earlier identification of disease progression and exacerbations, improve access to treatments and enhance quality-of-life (QoL). Patients from ILD specialised services in the UK were enrolled in a home monitoring programme and requested to perform one acceptable spirometry blow and one resting pulse oximetry reading at least once weekly. Thresholds were set for FVC and oxygen saturation according to baseline. If measurements fell below threshold, alerts were sent to a web-based portal. The clinicians reviewed the alerts and assessed the measurements, quality, trends, change from baseline and contributing factors leading to clinical intervention. The clinical effectiveness of home monitoring for patients with ILD in a real-world setting is not well understood. We aimed to evaluate the responses to home monitoring alerts and whether they led to earlier identification of disease progression and/or exacerbation, improved access to treatments and enhanced QoL interventions. Methods: A retrospective analysis of alerts generated from home monitoring measurements submitted over a 12-month period and a clinician response was undertaken. Data were analysed using descriptive statistics. Results: 186 patients were enrolled in the home monitoring programme between March 2022 and January 2023. 10 patients did not initiate home monitoring. A total of 1766 alerts were generated by 176 patients, of which 422 (18%) led to identification of clinical change and appropriate management. 242 (10%) of the alerts led to earlier consultation with the clinician, further investigation or local healthcare provider. Over 50% of the alerts did not require clinician intervention. This is demonstrated in table 1. Conclusion: A significant number of changes in clinical state were identified by alerts leading to changes in management. Home monitoring as part of a clinical care programme in people with ILD is clinically effective in a real-world population. The impact on admission avoidance and cost to the healthcare system remains unknown and warrants further investigation. Further research is required to demonstrate scalability and whether home monitoring measures can predict exacerbations or worsening disease.

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