Evaluating a Web-Based Coaching Program Using Electronic Health Records for Patients With Chronic Obstructive Pulmonary Disease in China: Randomized Controlled Trial

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Abstract

Background

Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the world, and it continues to increase in developing countries. The World Health Organization expects COPD to be the third most common cause of death in the world by 2020. Effective and continuous postdischarge care can help patients to maintain good health. The use of electronic health records (EHRs) as an element of community health care is new technology in China.

Objective

The aim of this study was to develop and evaluate a Web-based coaching program using EHRs for physical function and health-related quality of life for patients with COPD in China.

Methods

A randomized controlled trial was conducted from 2008 to 2015 at two hospitals. The control group received routine care and the intervention group received routine care with the addition of the Web-based coaching program using EHRs. These were used to manage patients’ demographic and clinical variables, publish relevant information, and have communication between patients and health care providers. Participants were not blinded to group assignment. The effects of the intervention were evaluated by lung function, including percent of forced expiratory volume in 1 second (FEV1%), percent of forced vital capacity (FVC%), peak expiratory flow (PEF), maximum midexpiratory flow; St George’s Respiratory Questionnaire (SGRQ); Modified Medical Research Council Dyspnea Scale (MMRC); and 6-Minute Walk Test (6MWT). Data were collected before the program, and at 1, 3, 6, and 12 months after the program.

Results

Of the 130 participants, 120 (92.3%) completed the 12-month follow-up program. There were statistically significant differences in lung function (FEV1%: F1,4=5.47, P=.002; FVC%: F1,4=3.06, P=.02; PEF: F1,4=12.49, P<.001), the total score of SGRQ (F1,4=23.30, P<.001), symptoms of SGRQ (F1,4=12.38, P<.001), the activity of SGRQ (F1,4=8.35, P<.001), the impact of SGRQ (F1,4=12.26, P<.001), MMRC (F1,4=47.94, P<.001), and 6MWT (F1,4=35.54, P<.001) between the two groups with the variation of time tendency.

Conclusions

The Web-based coaching program using EHRs in China appears to be useful for patients with COPD when they are discharged from hospital into the community. It promotes the sharing of patients’ medical information by hospital and community nurses, and achieves dynamic management and follow-up analysis for patients’ disease. In addition, this program can postpone the decreasing rate of lung function, improve quality of life, decrease dyspnea, and increase physical capacity.

Related collections

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Definition, structure, content, use and impacts of electronic health records: a review of the research literature.

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This paper reviews the research literature on electronic health record (EHR) systems. The aim is to find out (1) how electronic health records are defined, (2) how the structure of these records is described, (3) in what contexts EHRs are used, (4) who has access to EHRs, (5) which data components of the EHRs are used and studied, (6) what is the purpose of research in this field, (7) what methods of data collection have been used in the studies reviewed and (8) what are the results of these studies. A systematic review was carried out of the research dealing with the content of EHRs. A literature search was conducted on four electronic databases: Pubmed/Medline, Cinalh, Eval and Cochrane. The concept of EHR comprised a wide range of information systems, from files compiled in single departments to longitudinal collections of patient data. Only very few papers offered descriptions of the structure of EHRs or the terminologies used. EHRs were used in primary, secondary and tertiary care. Data were recorded in EHRs by different groups of health care professionals. Secretarial staff also recorded data from dictation or nurses' or physicians' manual notes. Some information was also recorded by patients themselves; this information is validated by physicians. It is important that the needs and requirements of different users are taken into account in the future development of information systems. Several data components were documented in EHRs: daily charting, medication administration, physical assessment, admission nursing note, nursing care plan, referral, present complaint (e.g. symptoms), past medical history, life style, physical examination, diagnoses, tests, procedures, treatment, medication, discharge, history, diaries, problems, findings and immunization. In the future it will be necessary to incorporate different kinds of standardized instruments, electronic interviews and nursing documentation systems in EHR systems. The aspects of information quality most often explored in the studies reviewed were the completeness and accuracy of different data components. It has been shown in several studies that the use of an information system was conducive to more complete and accurate documentation by health care professionals. The quality of information is particularly important in patient care, but EHRs also provide important information for secondary purposes, such as health policy planning. Studies focusing on the content of EHRs are needed, especially studies of nursing documentation or patient self-documentation. One future research area is to compare the documentation of different health care professionals with the core information about EHRs which has been determined in national health projects. The challenge for ongoing national health record projects around the world is to take into account all the different types of EHRs and the needs and requirements of different health care professionals and consumers in the development of EHRs. A further challenge is the use of international terminologies in order to achieve semantic interoperability.

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Author and article information

Contributors

Yaogang Wang:

Health Service ManagementSchool of Public HealthTianjin Medical University22 Qixiangtai RdTianjin,China86 022 8333663686 022 83336636wyg@tmu.edu.cn

ORCID: http://orcid.org/0000-0002-7325-0663

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: July 2017

Publication date (Electronic): 21 July 2017

Volume: 19

Issue: 7

Electronic Location Identifier: e264

Affiliations

[1] ¹ Community Nursing Section School of Nursing Tianjin Medical University Tianjin China

[2] ² Internet Section Information Center Tianjin Medical University Tianjin China

[3] ³ Health Service Management School of Public Health Tianjin Medical University Tianjin China

[4] ⁴ Respiratory Unit Department of Respiratory Care Tianjin First Center Hospital Tianjin China

[5] ⁵ Respiratory Unit Department of Respiratory Care General Hospital of Tianjin Medical University Tianjin China

Author notes

Corresponding Author: Yaogang Wang wyg@ 123456tmu.edu.cn

Author information

Lan Wang http://orcid.org/0000-0002-0430-4138

Lin He http://orcid.org/0000-0002-9203-4720

Yanxia Tao http://orcid.org/0000-0003-1730-0141

Li Sun http://orcid.org/0000-0002-8211-6124

Hong Zheng http://orcid.org/0000-0002-4677-7945

Yashu Zheng http://orcid.org/0000-0002-9111-1173

Yuehao Shen http://orcid.org/0000-0002-0322-9033

Suyan Liu http://orcid.org/0000-0001-7421-1239

Yue Zhao http://orcid.org/0000-0002-5170-7204

Yaogang Wang http://orcid.org/0000-0002-7325-0663

Article

Publisher ID: v19i7e264

DOI: 10.2196/jmir.6743

PMC ID: 5544894

PubMed ID: 28733270

SO-VID: 296cb366-eaad-4088-99e9-c23b1ca4ebd7

Copyright © ©Lan Wang, Lin He, Yanxia Tao, Li Sun, Hong Zheng, Yashu Zheng, Yuehao Shen, Suyan Liu, Yue Zhao, Yaogang Wang. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.07.2017.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 6 October 2016

Date revision requested : 15 January 2017

Date revision received : 17 January 2017

Date accepted : 29 May 2017

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