Risk Assessment and Telehealthcare Application in Chronic Disease

The management of chronic diseases has become the most common medical concerns around the world. The aims of this dissertation are to further evaluate the relative risk and conduct the applications of telehealthcare in chronic diseases. First, in terms of the change of glucose metabolism in patients with acute pancreatitis and patients with total gastrectomy and the survival of prognosis in patients with chronic obstructive pulmonary disease exacerbations, population-based cohort retrospective studies based on the Taiwan National Health Insurance Research Database (NHIRD) using data mining technologies showed that the burden of comorbidities has a significant role in patients with chronic diseases, and should be carefully evaluated and managed. On　the　other　hand,　the experimental results showed that total gastrectomy contributes to improved glucose metabolism in patients with total gastrectomy. Most importantly, patients　without　diabetes　but　who　had　total gastrectomy　had lower rates of newly diagnosed diabetes after total gastrectomy compared with the general population as assessed by control-to-case analysis. In an attempt to provide ubiquitous telehealthcare for patients with chronic disease, a telesurveillance system has been implemented with continuous biometric monitoring and the automatic alarm mechanism using information and communication technologies. The system can analyze synchronous data to detect deterioration at an early stage through long-term health monitoring and inform case managers immediately using instant biometrics monitors and automatic alarm mechanisms. Besides, the system allows users to derive electronic medical records (EMRs) from the hospital information systems using web services. Most importantly, the augmentation service of knowledge-based electrocardiogram interpretation based on the support vector machine is available to assist physicians doing decision-making in clinical practice. The experimental results showed that the recognition classifiers yielded 88.4% accuracy, 94.1% sensitivity, and 87.7% specificity in atrial fibrillation and 86.1% accuracy, 82.7% sensitivity, and 86.3% specificity in ventricular premature contraction, respectively. As of December 31, 2015, the telehealthcare program has served 2,761 patients, derived and monitored 1,716,256 physical data, and performed 268,278 interviews to offer total care to patients. Notably, the program provides feedback within four minutes of the patient measuring biometric data. The telecare service received a high degree of support (95.8 %) from the users. Besides, the randomized controlled trial aimed to investigate the effectiveness of telemonitoring in improving COPD patient outcome. During the follow-up period, time to first re-admission for COPD exacerbation was significantly increased in the telemonitoring group than in the usual care group. Telemonitoring was also associated with a reduced number of all-cause re-admissions and emergency room visits. In conclusion, both of medical staffs and patients could derive benefit health care from the telehealthcare service in many respects.