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Hicks N, Zhan J, Brual J, Abejirinde IOO, Alfred M. Escalation Pathways of Remote Patient Monitoring Programs for COVID-19 Patients in Canada and the United States: A Rapid Review. Telemed J E Health 2024. [PMID: 39269888 DOI: 10.1089/tmj.2024.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Abstract
Introduction: During the COVID-19 pandemic, hospitals in North America were overwhelmed with COVID-19 patients and had limited capacity to admit patients. Remote patient monitoring (RPM) programs were developed to monitor COVID-19 patients at home and reduce disease transmission and the demand on hospitals. A critical component of RPM programs is effective escalation pathways. The purpose of this review is to synthesize the implementation of escalation pathways of RPM programs for COVID-19 patients in Canada and the United States. Methods: The search identified 563 articles from Embase, PubMed, and Scopus. Following title and abstract screening, 131 were selected for full-text review, and 26 articles were included. Data were extracted on study location, patient eligibility and program size, data collection, monitoring team, escalation criteria, and escalation response. Results: The included studies were published between 2020 and 2022; 3 in Canada and 23 in the United States. The RPM programs collected physiological vital signs and symptom data, which were inputted manually by patients and health care workers or synced automatically. Escalations were triggered automatically or following manual review by nurses and physicians when signs and symptoms were concerning or reached a specific threshold. Escalations included emergency department referrals, physician appointments, and increased monitoring. Conclusion: Many decisions are required when designing RPM escalation pathways for patients with COVID-19, which is crucial to promptly address patients' changing health statuses and clinical needs. Future research is needed to evaluate the effectiveness of escalation pathways for COVID-19 patients through performance metrics and patient and health care worker experience.
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Affiliation(s)
- Nicole Hicks
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Jingjing Zhan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Janette Brual
- Research and Innovation Institute, Women's College Hospital, Toronto, Canada
| | - Ibukun-Oluwa Omolade Abejirinde
- Research and Innovation Institute, Women's College Hospital, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Myrtede Alfred
- Department of Mechanical and Industrial Engine, University of Toronto, Toronto, Canada
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Cornelis J, Christiaens W, de Meester C, Mistiaen P. Remote patient monitoring in patients with COVID-19 at home: literature review. JMIR Nurs 2024. [PMID: 39287362 DOI: 10.2196/44580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND During the pandemic healthcare providers implemented remote patient monitoring (RPM) for patients suffering from COVID-19. RPM is an interaction between healthcare professionals and patients who are in different locations, in which a certain number of patient's functioning parameters is assessed and followed up for a certain duration of time. By implementing RPM for these patients they obtained to reduce the strain on hospitals and primary care. OBJECTIVE With this literature review we aim at describing the characteristics of the RPM interventions, reporting on the patients with COVID-19 included in RPM, and providing an overview of outcome variables such as length of stay (LOS), hospital (re)admissions, and mortality. METHODS A combination of different searches in several database types (traditional databases, trial registers, daily (google) searches and daily Pubmed alerts) were run daily from March 2020 till December 2021. A search update for randomized clinical trials (RCT's) was done in April 2022. RESULTS The initial search yielded more than 4448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring studies from 160 centres. None of the 164 studies covering 248,431 included patients reported on the presence of a randomized control group. Studies described a 'prehosp' group (96 studies) with patients who had a suspected or confirmed COVID-19 diagnosis and for whom it was decided not to hospitalize them yet, but closely monitor them at home, or a 'posthosp' group (32 studies) with patients who were monitored at home after hospitalization for COVID-19; 34 studies described both groups, in 2 studies it was unclear. There is a large variety in number of emergency department (ED) visits (0-36% and 0-16%) and no convincing evidence that RPM leads to less or more ED-visits as well as hospital (re)admissions (0-30% and 0-22%) in prehosp and posthosp, respectively. Mortality was generally low, and there is weak to no evidence that RPM is associated with lower mortality. There is neither evidence that RPM shortens previous LOS. A literature update detected three small scale RCT's which could not demonstrate statistically significant differences in these outcomes. Most papers claim savings, however the scientific base for these claims is doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured, although many patients declined RPM for several reasons (eg, technological embarrassment, digital literacy, etc.). CONCLUSIONS Based on these results, there is no convincing evidence that RPM in COVID-19 patients could avoid ED-visits or hospital (re)admissions, could shorten LOS or reduce mortality, but neither is there evidence that RPM has adverse outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework. CLINICALTRIAL
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Affiliation(s)
- Justien Cornelis
- Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, Brussels, BE
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Yahya G, O'Keefe JB, Moore MA. Comparing a Data Entry Tool to Provider Insights Alone for Assessment of COVID-19 Hospitalization Risk: Pilot Matched Cohort Comparison Study. JMIR Form Res 2023; 7:e44250. [PMID: 37903299 PMCID: PMC10691529 DOI: 10.2196/44250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 10/07/2023] [Accepted: 10/27/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND In March 2020, the World Health Organization declared COVID-19 a global pandemic, necessitating an understanding of factors influencing severe disease outcomes. High COVID-19 hospitalization rates underscore the need for robust risk prediction tools to determine estimated risk for future hospitalization for outpatients with COVID-19. We introduced the "COVID-19 Risk Tier Assessment Tool" (CRTAT), designed to enhance clinical decision-making for outpatients. OBJECTIVE We investigated whether CRTAT offers more accurate risk tier assignments (RTAs) than medical provider insights alone. METHODS We assessed COVID-19-positive patients enrolled at Emory Healthcare's Virtual Outpatient Management Clinic (VOMC)-a telemedicine monitoring program, from May 27 through August 24, 2020-who were not hospitalized at the time of enrollment. The primary analysis included patients from this program, who were later hospitalized due to COVID-19. We retroactively formed an age-, gender-, and risk factor-matched group of nonhospitalized patients for comparison. Data extracted from clinical notes were entered into CRTAT. We used descriptive statistics to compare RTAs reported by algorithm-trained health care providers and those produced by CRTAT. RESULTS Our patients were primarily younger than 60 years (67% hospitalized and 71% nonhospitalized). Moderate risk factors were prevalent (hospitalized group: 1 among 11, 52% patients; 2 among 2, 10% patients; and ≥3 among 4, 19% patients; nonhospitalized group: 1 among 11, 52% patients, 2 among 5, 24% patients, and ≥3 among 4, 19% patients). High risk factors were prevalent in approximately 45% (n=19) of the sample (hospitalized group: 11, 52% patients; nonhospitalized: 8, 38% patients). Approximately 83% (n=35) of the sample reported nonspecific symptoms, and the symptoms were generally mild (hospitalized: 12, 57% patients; nonhospitalized: 14, 67% patients). Most patient visits were seen within the first 1-6 days of their illness (n=19, 45%) with symptoms reported as stable over this period (hospitalized: 7, 70% patients; nonhospitalized: 3, 33% patients). Of 42 matched patients (hospitalized: n=21; nonhospitalized: n=21), 26 had identical RTAs and 16 had discrepancies between VOMC providers and CRTAT. Elements that led to different RTAs were as follows: (1) the provider "missed" comorbidity (n=6), (2) the provider noted comorbidity but undercoded risk (n=10), and (3) the provider miscoded symptom severity and course (n=7). CONCLUSIONS CRTAT, a point-of-care data entry tool, more accurately categorized patients into risk tiers (particularly those hospitalized), underscored by its ability to identify critical factors in patient history and clinical status. Clinical decision-making regarding patient management, resource allocation, and treatment plans could be enhanced by using similar risk assessment data entry tools for other disease states, such as influenza and community-acquired pneumonia. The COVID-19 pandemic has accelerated the adoption of telemedicine, enabling remote patient tools such as CRTAT. Future research should explore the long-term impact of outpatient clinical risk assessment tools and their contribution to better patient care.
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Affiliation(s)
- Gezan Yahya
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - James B O'Keefe
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Miranda A Moore
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
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Wang L, Arky M, Ierardo A, Scanlin A, Templeton M, Booker E. Large-scale Implementation of a COVID-19 Remote Patient Monitoring Program. West J Emerg Med 2023; 24:1085-1093. [PMID: 38165191 PMCID: PMC10754188 DOI: 10.5811/westjem.60172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction We implemented a large-scale remote patient monitoring (RPM) program for patients diagnosed with coronavirus 2019 (COVID-19) at a not-for-profit regional healthcare system. In this retrospective observational study, patients from nine emergency department (ED) sites were provided a pulse oximeter and enrolled onto a monitoring platform upon discharge. Methods The RPM team captured oxygen saturation (SpO2), heart rate, temperature, and symptom progression data over a 16-day monitoring period, and the team engaged patients via video call, phone call, and chat within the platform. Abnormal vital signs were flagged by the RPM team, with escalation to in-person care and return to ED as appropriate. Our primary outcome was to describe study characteristics: patients enrolled in the COVID-19 RPM program; engagement metrics; and physiologic and symptomatic data trends. Our secondary outcomes were return-to-ED rate and subsequent readmission rate. Results Between December 2020-August 2021, a total of 3,457 patients were referred, and 1,779 successfully transmitted at least one point of data. Patients on COVID-19 RPM were associated with a lower 30-day return-to-ED rate (6.2%) than those not on RPM (14.9%), with capture of higher acuity patients (47.7% of RPM 30-day returnees were subsequently hospitalized vs 34.8% of non-RPM returnees). Conclusion Our program, one of the largest studies to date that captures both physiologic and symptomatic data, may inform others who look to implement a program of similar scope. We also share lessons learned regarding barriers and disparities in enrollment and discuss implications for RPM in other acute disease states.
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Affiliation(s)
- Lulu Wang
- MedStar Washington Hospital Center, Department of Emergency Medicine, Washington, DC
- MedStar Telehealth Innovation Center, MedStar Institute for Innovation, Washington, DC
| | - Marisa Arky
- MedStar Telehealth Innovation Center, MedStar Institute for Innovation, Washington, DC
| | - Alyssa Ierardo
- Georgetown University Hospital and Washington Hospital Center Emergency Medicine Residency, Washington, DC
| | - Anna Scanlin
- Georgetown University Hospital and Washington Hospital Center Emergency Medicine Residency, Washington, DC
| | - Melissa Templeton
- Georgetown University Hospital and Washington Hospital Center Emergency Medicine Residency, Washington, DC
| | - Ethan Booker
- MedStar Washington Hospital Center, Department of Emergency Medicine, Washington, DC
- MedStar Telehealth Innovation Center, MedStar Institute for Innovation, Washington, DC
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Bernocchi P, Crotti G, Beato E, Bonometti F, Giudici V, Bertolaia P, Perger E, Remuzzi A, Bachetti T, La Rovere MT, Dalla Vecchia LA, Angeli F, Parati G, Borghi G, Vitacca M, Scalvini S. COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy). Front Cardiovasc Med 2023; 10:1062232. [PMID: 37645519 PMCID: PMC10461473 DOI: 10.3389/fcvm.2023.1062232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Background During the COVID-19 pandemic, telemedicine has been recognised as a powerful modality to shorten the length of hospital stay and to free up beds for the sicker patients. Lombardy, and in particular the areas of Bergamo, Brescia, and Milan, was one of the regions in Europe most hit by the COVID-19 pandemic. The primary aim of the MIRATO project was to compare the incidence of severe events (hospital readmissions and mortality) in the first three months after discharge between COVID-19 patients followed by a Home-Based Teleassistance and Teleconsultation (HBTT group) program and those discharged home without Telemedicine support (non-HBTT group). Methods The study was designed as a matched case-control study. The non-HBTT patients were matched with the HBTT patients for sex, age, presence of COVID-19 pneumonia and number of comorbidities. After discharge, the HBTT group underwent a telecare nursing and specialist teleconsultation program at home for three months, including monitoring of vital signs and symptoms. Further, in this group we analysed clinical data, patients' satisfaction with the program, and quality of life. Results Four hundred twenty-two patients per group were identified for comparison. The median age in both groups was 70 ± 11 years (62% males). One or more comorbidities were present in 86% of the HBTT patients and 89% in the non-HBTT group (p = ns). The total number of severe events was 17 (14 hospitalizations and 3 deaths) in the HBTT group and 40 (26 hospitalizations and 16 deaths) in the non-HBTT group (p = 0.0007). The risk of hospital readmission or death after hospital discharge was significantly lower in HBTT patients (Log-rank Test p = 0.0002). In the HBTT group, during the 3-month follow-up, 5,355 teleassistance contacts (13 ± 4 per patient) were performed. The number of patients with one or more symptoms declined significantly: from 338 (78%) to 183 (45%) (p < 0.00001). Both the physical (ΔPCS12: 5.9 ± 11.4) component and the mental (ΔMCS12: 4.4 ± 12.7) component of SF-12 improved significantly (p < 0.0001). Patient satisfaction with the program was very high in all participants. Conclusions Compared to usual care, an HBTT program can reduce severe events (hospital admissions/mortality) at 3-months from discharge and improve symptoms and quality of life. Clinical trial registration www.ClinicalTrials.gov, NCT04898179.
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Affiliation(s)
- Palmira Bernocchi
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Giacomo Crotti
- Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy
| | - Elvira Beato
- Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy
| | - Francesco Bonometti
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Vittorio Giudici
- Department of Cardiac Rehabilitation, Bolognini Hospital, Azienda Socio Sanitaria Territoriale Bergamo Est, Bergamo, Italy
| | - Patrizia Bertolaia
- Socio-Health Management Direction, Azienda Socio Sanitaria Territoriale Bergamo Est, Bergamo, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Andrea Remuzzi
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Tiziana Bachetti
- Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Maria Teresa La Rovere
- Cardiac Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Montescano, Pavia, Italy
| | | | - Fabio Angeli
- Department of Medicine and Technological Innovativon (DiMIT), University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate, Varese, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gabriella Borghi
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Michele Vitacca
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Simonetta Scalvini
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
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Majoor K, Vorselaars AD. Home monitoring of coronavirus disease 2019 patients in different phases of disease. Curr Opin Pulm Med 2023; 29:293-301. [PMID: 37158218 PMCID: PMC10241420 DOI: 10.1097/mcp.0000000000000964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE OF REVIEW Various home monitoring programs have emerged through the COVID-19 pandemic in different phases of COVID-19 disease. RECENT FINDINGS The prehospital monitoring of COVID-19-positive patients detects early deterioration. Hospital care at home provides early discharge with oxygen to empty hospital beds for other patients. Home monitoring during recovery can be used for rehabilitation and detection of potential relapses. General goals of home monitoring in COVID-19 are early detection of deterioration and prompt escalation of care such as emergency department presentation, medical advice, medication prescription and mental support. Due to the innovations of vaccination and treatment changes, such as dexamethasone and tocilizumab, the challenge for the healthcare system has shifted from large numbers of admitted COVID-19 patients to lower numbers of admitted patients with specific risk profiles (such as immunocompromised). This also changes the field of home monitoring in COVID-19. Efficacy and cost-effectiveness of home monitoring interventions depend on the costs of the intervention (use of devices, apps and medical staff) and the proposed patient group (depending on risk factors and disease severity). SUMMARY Patient satisfaction of COVID-19 home monitoring programs was mostly high. Home monitoring programs for COVID-19 should be ready to be re-escalated in case of a new global pandemic.
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Affiliation(s)
| | - Adriane D.M. Vorselaars
- Division of Heart and Lungs, University Medical Center Utrecht
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
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Witkowska-Zimny M, Nieradko-Iwanicka B. Telemedicine in Emergency Medicine in the COVID-19 Pandemic-Experiences and Prospects-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8216. [PMID: 35805873 PMCID: PMC9266315 DOI: 10.3390/ijerph19138216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/06/2023]
Abstract
Even before the year 2020, telemedicine has been proven to contribute to the efficacy of healthcare systems, for example in remote locations or in primary care. However, with the outbreak of the COVID-19 pandemic, telehealth solutions have emerged as a key component in patient healthcare delivery and they have been widely used in emergency medicine ever since. The pandemic has led to a growth in the number of telehealth applications and improved quality of already available telemedicine solutions. The implementation of telemedicine, especially in emergency departments (EDs), has helped to prevent the spread of COVID-19 and protect healthcare workers. This narrative review focuses on the most important innovative solutions in emergency care delivery during the COVID-19 pandemic. It outlines main categories of active telehealth use in daily practice of dealing with COVID-19 patients currently, and in the future. Furthermore, it discusses benefits as well as limitations of telemedicine.
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Affiliation(s)
| | - Barbara Nieradko-Iwanicka
- Chair and Department of Hygiene and Epidemiology, Medical University of Lublin, 7 Chodzki Str., 20-093 Lublin, Poland;
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Crotty BH, Dong Y, Laud P, Hanson RJ, Gershkowitz B, Penlesky AC, Shah N, Anderes M, Green E, Fickel K, Singh S, Somai MM. Hospitalization Outcomes Among Patients With COVID-19 Undergoing Remote Monitoring. JAMA Netw Open 2022; 5:e2221050. [PMID: 35797044 PMCID: PMC9264036 DOI: 10.1001/jamanetworkopen.2022.21050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Health care systems have implemented remote patient monitoring (RPM) programs to manage patients with COVID-19 at home, but the associations between participation and outcomes or resource utilization are unclear. Objective To assess whether an RPM program for COVID-19 is associated with lower or higher likelihood of hospitalization and whether patients who are admitted present earlier or later for hospital care. Design, Setting, and Participants This retrospective, observational, cohort study of RPM was performed at Froedtert & Medical College of Wisconsin Health Network, an academic health system in southeastern Wisconsin. Participants included patients with internal primary care physicians and a positive SARS-CoV-2 test in the ambulatory setting between March 30, 2020, and December 15, 2020. Data analysis was performed from February 15, 2021, to February 2, 2022. Exposures Activation of RPM program. Main Outcomes and Measures Hospitalizations within 2 to 14 days of a positive test. Inverse propensity score weighting was used to account for differences between groups. Sensitivity analyses were performed looking at usage of the RPM among patients who activated the program. Results A total of 10 660 COVID-19-positive ambulatory patients were eligible, and 9378 (88.0%) had email or mobile numbers on file and were invited into the RPM program; the mean (SD) age was 46.9 (16.3) years and 5448 patients (58.1%) were women. Patients who activated monitoring (5364 patients [57.2%]) had a mean (SD) of 35.3 (33.0) check-ins and a mean (SD) of 1.27 (2.79) (median [IQR], 0 [0-1]) free-text comments. A total of 878 patients (16.4%) experienced at least 1 alert; 128 of 5364 activated patients (2.4%) and 158 of 4014 inactivated patients (3.9%) were hospitalized (χ21 = 18.65; P < .001). In weighted regression analysis, activation of RPM was associated with a lower odds of hospitalization (odds ratio, 0.68; 95% CI, 0.54-0.86; P = .001) adjusted for demographics, comorbidities, and time period. Monitored patients had a longer mean (SD) time between test and hospitalization (6.67 [3.21] days vs 5.24 [3.03] days), a shorter length of stay (4.44 [4.43] days vs 7.14 [8.63] days), and less intensive care use (15 patients [0.3%] vs 44 patients [1.1%]). Conclusions and Relevance These findings suggest that activation of an RPM program is associated with lower hospitalization, intensive care use, and length of stay among patients with COVID-19.
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Affiliation(s)
- Bradley H. Crotty
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Yilu Dong
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Purushottam Laud
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Ryan J. Hanson
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Bradley Gershkowitz
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Annie C. Penlesky
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Neemit Shah
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Michael Anderes
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Erin Green
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Karen Fickel
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Siddhartha Singh
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Melek M. Somai
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
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Oh SM, Nair S, Casler A, Nguyen D, Forero JP, Joco C, Kubert J, Esses D, Adams D, Jariwala S, Leff J. A prospective observational study evaluating the use of remote patient monitoring in ED discharged COVID-19 patients in NYC. Am J Emerg Med 2022; 55:64-71. [PMID: 35279578 PMCID: PMC8868022 DOI: 10.1016/j.ajem.2022.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES We investigated whether continuous remote patient monitoring (RPM) could significantly reduce return Emergency Department (ED) revisits among coronavirus disease 2019 (COVID-19) patients discharged from the emergency Department. MATERIALS AND METHODS A prospective observational study was conducted from a total of 2833 COVID-19 diagnosed patients who presented to the Montefiore Medical Center ED between September 2020-March 2021. Study patients were remotely monitored through a digital platform that was supervised 24/7 by licensed healthcare professionals. Age and time-period matched controls were randomly sampled through retrospective review. The primary outcome was ED revisit rates among the two groups. RESULTS In our study, 150 patients enrolled in the RPM program and 150 controls were sampled for a total of 300 patients. Overall, 59.1% of the patients identified as Hispanic/Latino. The RPM group had higher body mass index (BMI) (29 (25-35) vs. 27 (25-31) p-value 0.020) and rates of hypertension (50.7% (76) vs. 35.8% (54) p-value 0.009). There were no statistically significant differences in rates of ED revisit between the RPM group (8% (12)) and control group (9.3% (14)) (OR: 0.863; 95% CI:0.413-1. 803; p- 0.695). DISCUSSION AND CONCLUSION Our study explored the impact of continuous monitoring versus intermittent monitoring for reducing ED revisits in a largely underrepresented population of the Bronx. Our study demonstrated that continuous remote patient monitoring showed no significant difference in preventing ED revisits compared to non-standardized intermittent monitoring. However, potential other acute care settings where RPM may be useful for identifying high-risk patients for early interventions warrant further study.
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