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Advances in the Application of Information and Communication Technologies in Healthcare at the Patient's Home

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Advances in the Application of Information and Communication Technologies in Healthcare at the Patient's Home Advances in the application of information and communication technologies in healthcare at the patient's home Valentina Isetta Aquesta tesi doctoral està subjecta a la llicència Reconeixement- CompartIgual 3.0. Espanya de Creative Commons. Esta tesis doctoral está sujeta a la licencia Reconocimiento - CompartirIgual 3.0. España de Creative Commons. This doctoral thesis is licensed under the Creative Commons Attribution-ShareAlike 3.0. Spain License. ADVANCES IN THE APPLICATION OF INFORMATION AND COMMUNICATION TECHNOLOGIES IN HEALTH CARE AT THE PATIENT'S HOME Memòria presentada per Valentina Isetta per optar al títol de Doctora Director de la tesi: Dr. Ramon Farré Ventura Unitat de Biofísica i Bioenginyeria Facultat de Medicina Universitat de Barcelona If you put your mind to it, you can accomplish anything. Marty McFly, “Back to the future”, 1985 ACKNOWLEDGMENTS I would like to thank all the people that supported me in these intense years of work. First of all, my gratitude goes to Prof. Ramon Farré, for his solid trust since my early beginning in Barcelona and for seeing in me a researcher that I never imagined I could be. Many thanks to Dr. Josep M. Montserrat, for his irreplaceable mentoring in the clinical world and for his advice and affection. Thanks also to all his medical and nursing staff of the Sleep Lab of the Hospital Clinic of Barcelona, where I have learned a lot and I have felt as another team member. A special thank to Carmen Lopez, for her affectionate help and splendid work to create “Petits a casa”. Without her tenacity and the collaboration of all nursing and medical staff of the Hospital de Sant Pau Neonatology department this successful service to the community would not exist. Thanks to Prof. Raffaele Dellacà and all the TBM Lab fellows for the support and friendship since my period of graduate studies at the Politecnico di Milano. A huge thank to all the actual and former UBB fellows, with whom I spent unforgettable moments of fun and craziness and for becoming my special family in Barcelona. Finally I would like to thank Albert for his love and respect and my fantastic family for their unconditional support to all my life choices. TABLE OF CONTENTS CHAPTER 1. INTRODUCTION .................................................................................................................. 11 1.1 Telemedicine .................................................................................................................................................... 11 1.2 Telemedicine in home care ............................................................................................................................. 14 1.3 Addressing three specific applications of home telemedicine ................................................................... 19 1.4 Reference List .................................................................................................................................................. 21 CHAPTER 2. AIMS AND HYPOTHESES OF THE THESIS ...................................................................... 25 2.1 General aim ...................................................................................................................................................... 25 2.2 Hypotheses ...................................................................................................................................................... 25 2.3 Specific aims .................................................................................................................................................... 25 CHAPTER 3. COST-EFFECTIVENESS OF A NEW INTERNET-BASED MONITORING TOOL FOR NEONATAL POST-DISCHARGE HOME CARE ........................................................................................ 27 3.1 Introduction ...................................................................................................................................................... 27 3.2 Hypotheses ...................................................................................................................................................... 28 3.3 Aims .................................................................................................................................................................. 28 3.4 Methods ............................................................................................................................................................ 29 3.5 Results .............................................................................................................................................................. 33 3.6 Discussion ....................................................................................................................................................... 35 3.7 Reference List .................................................................................................................................................. 41 CHAPTER 4. A MULTICENTER SUPPORT SYSTEM FOR CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY FOLLOW-UP IN OBSTRUCTIVE SLEEP APNEA .............................................. 45 4.1 Introduction ...................................................................................................................................................... 45 4.2 Hypotheses ...................................................................................................................................................... 46 4.3 Aims .................................................................................................................................................................. 46 4.4 Methods ............................................................................................................................................................ 47 4.5 Results .............................................................................................................................................................. 55 4.6 Discussion ....................................................................................................................................................... 63 4.7 Reference List .................................................................................................................................................. 68 CHAPTER 5. VALIDATION OF A TELEMONITORING SYSTEM FOR OBSTRUCTIVE SLEEP APNEA TREATMENT .............................................................................................................................................. 71 5.1 Introduction ...................................................................................................................................................... 71 5.2 Hypothesis ....................................................................................................................................................... 72 5.3 Aims .................................................................................................................................................................. 72 5.4 Methods ............................................................................................................................................................ 72 5.5 Results .............................................................................................................................................................. 81 5.6 Discussion ....................................................................................................................................................... 84 5.7 Reference list ................................................................................................................................................... 87 CHAPTER 6. CONCLUSIONS ................................................................................................................... 89 6.1 Cost-Effectiveness of a New Internet-based Monitoring Tool for Neonatal Post Discharge Home Care 89 6.2 A Multicenter Support System for Continuous Positive Airway Pressure Therapy Follow-up in Obstructive Sleep Apnea ........................................................................................................................................... 90 6.3 Validation of a Telemonitoring System for Obstructive Sleep Apnea Treatment ...................................... 90 APPENDIX A. PUBLICATIONS AND COMMUNICATIONS TO CONGRESSES ..................................... 93 APPENDIX B. PARTICIPATION TO PROJECTS ...................................................................................... 95 APPENDIX C. SOURCE CODE OF THE IMPLEMENTED APPLICATIONS ............................................ 97 C.1 Babies at home Internet-based application ............................................................................................. 97 C.2 Mi-cpap multicenter web application ..................................................................................................... 187 C.3 Validation of a new CPAP telemonitoring system ................................................................................ 226 Chapter 1 INTRODUCTION 1.1 TELEMEDICINE Almost half a century ago, telemedicine was initially ignored for being considered an unreliable and unaffordable technology. In recent years, the rapid evolution of communication and information technologies (ICTs) has provided a solid basis for telemedicine as a feasible, reliable and helpful tool for delivering healthcare. Clinical researchers from
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