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* From the Department of Medical Informatics (Drs. Finkelstein and Hripcsak), Columbia University, New York, NY; and the Division of Pulmonary Medicine (Dr. Cabrera), Columbia Presbyterian Medical Center, New York, NY.
Correspondence to: Joseph Finkelstein, MD, PhD, Doctors Office Building, Suite 1102, 720 Harrison Ave, Boston, MA 02118; e-mail: finkelj{at}bu.edu
Study objective: To evaluate the validity of spirometry self-testing during home telemonitoring and to assess the acceptance of an Internet-based home asthma telemonitoring system by asthma patients.
Design: We studied an Internet-based telemonitoring system that collected spirometry data and symptom reports from asthma patients’ homes for review by physicians in the medical center’s clinical information system. After a 40-min training session, patients completed an electronic diary and performed spirometry testing twice daily on their own from their homes for 3 weeks. A medical professional visited each patient by the end of the third week of monitoring, 10 to 40 min after the patient had performed self-testing, and asked the patient to perform the spirometry test again under his supervision. We evaluated the validity of self-testing and surveyed the patients attitude toward the technology using a standardized questionnaire.
Setting: Telemonitoring was conducted in patients’ homes in a low-income inner city area.
Patients: Thirty-one consecutive asthma patients without regard to computer experience.
Measurement and results: Thirty-one asthma patients completed 3 weeks of monitoring. A paired t test showed no difference between unsupervised and supervised home spirometry self-testing. The variability of FVC (4.1%), FEV1 (3.7%), peak expiratory flow (7.9%), and other spirometric indexes in our study was similar to the within-subject variability reported by other researchers. Despite the fact that the majority of the patients (71%) had no computer experience, they indicated that the self-testing was "not complicated at all" or only "slightly complicated." The majority of patients (87.1%) were strongly interested in using home asthma telemonitoring in the future.
Conclusions: Spirometry self-testing by asthma patients during telemonitoring is valid and comparable to those tests collected under the supervision of a trained medical professional. Internet-based home asthma telemonitoring can be successfully implemented in a group of patients with no computer background.
Key Words: asthma • peak expiratory flow • self-management • spirometry • telemonitoring
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