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Adherence with any long-term treatment or research protocol is a challenge; this has been found to be the case with lung transplant recipients participating in an electronic home spirometry research program. Because the purpose of the current study is to develop a system for detecting early infection and rejection in lung transplant recipients, regular transmission of data by subjects to the research data center is imperative to the success of the study. Various adherence-promoting strategies have been developed by the research team to increase subject adherence with the program. An increased adherence rate has been reported after implementation of these various strategies, yet work remains to promote continually regular participation in the program by all subjects. It remains a challenge for the research team to devise creative and effective strategies for increasing adherence to regular spirometer use to provide data to develop a computerized system for detecting early infection and rejection of transplanted lung tissue.

Two strategies for teaching lung and heart-lung transplant subjects to use an electronic spirometer/diary instrument at home to input and transmit daily respiratory, vital sign, and symptom measurements were compared. The first strategy integrated teaching into subjects' postoperative clinic visits, whereas the second strategy involved referral to a Patient Learning Center (PLC) for instruction. Adherence was increased by 30% when the teaching was transferred from the clinic setting to the PLC. These findings suggest that the PLC is an effective resource for preparing patients to manage their care after discharge from a hospital or clinic.

Objective: To demonstrate that home spirometry measurements are reliable and valid and can be used as part of a home measurement monitoring system by lung transplant recipients., Design: Longitudinal, observational., Setting: University medical center., Subjects: Eighteen patients who have undergone lung transplantation; age range was 24 to 63 years (mean of 49.5 years)., Outcome Measures: Reliability and validity of forced expiratory volume at 1 second (FEV1) and forced vital capacity (FVC)., Intervention: Recording of spirometry, vital signs, and symptom measures at home each day by use of a paperless electronic diary/spirometer instrument., Results: Day-to-day variability as measured by the standard deviation ranged from 0.013 L to 0.202 L for FVC and 0.015 L to 0.117 L for FEV1. The correlation between the two best forced expiratory maneuvers on any given day was 0.98 for both FVC and FEV1, with percent differences between the measurements of 2% for FVC and 3% for FEV1. The correlation between measurements performed in the pulmonary function laboratory and measurements done by the patient at home on the same day was 0.94 for FVC and 0.99 for FEV1., Conclusions: This evaluation demonstrated that home measurements are both reliable (i.e., repeatable) and valid when compared with the "gold standard" of the pulmonary function laboratory. The home monitoring program has been well accepted by patients, is easy to use, and provides data comparable to that collected during clinic visits.