The overall objective of this study is to develop an early detection system to improve outcomes for lung transplant recipients during the entire life-cycle of the transplant experience - including both the pre transplant candidate period and the post-transplant recovery period. This study will evaluate a decision support system for the early detection of rejection and infection in lung transplant recipients, analyze long-term outcomes to assess the effectiveness of early detection on improving transplant recipients health condition, and develop a communication building strategy between pre-transplant candidates on the organ donor waiting list and their nurse clinical coordinator so that potential risks for transplant surgery can be quickly identified and subsequently reduced by timely intervention focused on each subjects specific problems. Both pre- and post transplant subjects will record regular daily or weekly measurements at home using paperless, electronic monitors. Recorded data is transmitted to the study data center once each week using the modem in the monitor and standard voice-grade telephones. The measurements have been selected to be clinically useful in detecting post-transplant infection or rejection, or increased risk for surgery in the transplant candidate. Both monitor systems will provide improved continuity of care into the home setting by delivering basic nurse-patient interaction in training patients for early detection of infection or rejection in post-transplant subjects to participate more fully in the care of their chronic illness, and in providing timely information on patient status so that potential problems can be detected early and appropriate and effective intervention can be initiated. An early detection decision system using lung volume, flow, and symptoms such as coughing, sputum production, shortness of breath obtained from home monitoring has been developed for the post-transplant period. This system has demonstrated that lung transplant recipients can and will do regular home measurements, and that these measurements can detect early signs of infection or rejection in the transplanted lung. The current study will determine if such early detection and associated intervention can improve survival and quality of life for the lung recipient. The combined pre- and post-transplant monitors will provide new knowledge for caring for transplant patients, will prevent further disease progression, and mitigate the potentially disastrous effects of infection and rejection on the study population. The home monitoring concept and devices should also be transferable to the care of patients with other chronic respiratory diseases.
| Wang, Wayne; Finkelstein, Stanley M; Hertz, Marshall I (2013) Automatic event detection in lung transplant recipients based on home monitoring of spirometry and symptoms. Telemed J E Health 19:658-63 |
| Yoon, Hojung J; Yoon, Hojung Joseph; Guo, Hongfei et al. (2008) Adherence to home-monitoring and its impact on survival in post-lung transplantation patients. AMIA Annu Symp Proc :835-8 |
| Pieczkiewicz, David S; Finkelstein, Stanley M; Hertz, Marshall I (2007) Design and evaluation of a web-based interactive visualization system for lung transplant home monitoring data. AMIA Annu Symp Proc :598-602 |
| Adam, Terrence J; Finkelstein, Stanley M; Parente, Stephen T et al. (2007) Cost analysis of home monitoring in lung transplant recipients. Int J Technol Assess Health Care 23:216-22 |
| Finkelstein, Stanley M; Ratner, Edward (2006) Managing chronic disease through home telehealth. Minn Med 89:42-5 |
| Troiani, John S; Finkelstein, Stanley M; Hertz, Marshall I (2005) Incomplete event documentation in medical records of lung transplant recipients. Prog Transplant 15:173-7 |
| Finkelstein, Stanley M; Scudiero, Anthony; Lindgren, Bruce et al. (2005) Decision support for the triage of lung transplant recipients on the basis of home-monitoring spirometry and symptom reporting. Heart Lung 34:201-8 |
| Mullan, Beth; Snyder, Mariah; Lindgren, Bruce et al. (2003) Home monitoring for lung transplant candidates. Prog Transplant 13:176-82 |
| Lindgren, Bruce R; Snyder, Mariah; Sabati, Navid et al. (2002) Health locus of control and adherence with home spirometry use in lung transplant recipients. Prog Transplant 12:24-9 |
| Sabati, N; Snyder, M; Edin-Stibbe, C et al. (2001) Facilitators and barriers to adherence with home monitoring using electronic spirometry. AACN Clin Issues 12:178-85 |
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