VISN 23 Chronic Obstructive Pulmonary Disease (COPD) Case Management Using Home Telehealth Equipment

Patients who have been admitted to the hospital, or who have frequent urgent care visits,
who also suffer from COPD exacerbations will be given a home monitoring system. Daily, the
patient will respond to a series of questions. The results of the question answers will be
remotely monitored by a nurse case manager.

The objective is to measure compliance, resource use, and the ability for early recognition
of an exacerbation of their COPD, and early implementation of therapy.

Inclusion Criteria:

- One or more hospital admissions or emergency room visits in last 2 Years.

- Patient must meet the VA home telehealth guideline that the patient is determined to
be at high risk for poor clinical outcomes or increased unplanned health care
utilization based on disease specific criteria and/or determined by physician
provider

Exclusion Criteria:

- Any unstable medical condition that the investigator thinks would preclude effective
participation in the study, or which would be expected to reduce life expectancy to
less than 1 year.

- Unwilling or unable to provide consent

- Uncooperative or combative

- Does not have a compatible phone line

- Inability to use home telemedicine equipment