The COVID-19 pandemic and resultant need for social distancing accelerated the need to develop remote monitoring of graft function in lung transplant recipients. While home spirometry has been used previously in lung transplantation, prior work shows long-term engagement is poor. We aimed to deploy Bluetooth enabled home spirometers coupled with a digital chatbot to improve engagement and allow efficient data and symptoms.
We designed and implemented an automated, chat-based mobile health intervention paired with Bluetooth-enabled home spirometers. Transplant recipients received text messages or emails, allowing them to engage in a personalized, automated chat with symptom assessment, education modules, and spirometer data collection. The chat engaged patients weekly and allowed them to also initiate chats. Concerning symptoms or FEV1 declines were escalated to the team.
We mailed home spirometers to 424 patients starting April 2020 and launched an automated, interactive chatbot program. Between 5/4/2020 and 10/21/2020, 311 total patients enrolled in the automated chat. Of the 273 patients that submitted at least 1 FEV1 value, they submitted a median 13 (IQR 6-23) FEV1 values over 24 weeks. The largest drop in FEV1 engagement came after the first week in each patient’s chat experience, with 64.7% of those that submitted an FEV1 at baseline continuing to do so into week one and 71.8% in week two. However, after the initial drop, FEV engagement remained stable between 56.3 and 71.8% through 24 weeks.
Lung transplant recipients engaged at high rates with a chat-based mobile health intervention and consistently used Bluetooth-enabled home spirometers to report their FEV1, allowing close home-based monitoring of medically vulnerable transplant recipients. Given the projected need for social distancing, and increasing role of telemedicine for long term management, a chatbot mobile health linked home spirometer may be a powerful tool at detecting early graft dysfunction.