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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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Rodriguez JA, Rudin RS, Dalal AK. Digitally powered care transitions: A paradigm shift for hospital medicine. J Hosp Med 2024; 19:739-743. [PMID: 38258515 DOI: 10.1002/jhm.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Jorge A Rodriguez
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anuj K Dalal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Vasudevan A, Plombon S, Piniella N, Garber A, Malik M, O'Fallon E, Goyal A, Gershanik E, Kumar V, Fiskio J, Yoon C, Lipsitz SR, Schnipper JL, Dalal AK. Effect of digital tools to promote hospital quality and safety on adverse events after discharge. J Am Med Inform Assoc 2024:ocae176. [PMID: 39013194 DOI: 10.1093/jamia/ocae176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/10/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024] Open
Abstract
OBJECTIVES Post-discharge adverse events (AEs) are common and heralded by new and worsening symptoms (NWS). We evaluated the effect of electronic health record (EHR)-integrated digital tools designed to promote quality and safety in hospitalized patients on NWS and AEs after discharge. MATERIALS AND METHODS Adult general medicine patients at a community hospital were enrolled. We implemented a dashboard which clinicians used to assess safety risks during interdisciplinary rounds. Post-implementation patients were randomized to complete a discharge checklist whose responses were incorporated into the dashboard. Outcomes were assessed using EHR review and 30-day call data adjudicated by 2 clinicians and analyzed using Poisson regression. We conducted comparisons of each exposure on post-discharge outcomes and used selected variables and NWS as independent predictors to model post-discharge AEs using multivariable logistic regression. RESULTS A total of 260 patients (122 pre, 71 post [dashboard], 67 post [dashboard plus discharge checklist]) enrolled. The adjusted incidence rate ratios (aIRR) for NWS and AEs were unchanged in the post- compared to pre-implementation period. For patient-reported NWS, aIRR was non-significantly higher for dashboard plus discharge checklist compared to dashboard participants (1.23 [0.97,1.56], P = .08). For post-implementation patients with an AE, aIRR for duration of injury (>1 week) was significantly lower for dashboard plus discharge checklist compared to dashboard participants (0 [0,0.53], P < .01). In multivariable models, certain patient-reported NWS were associated with AEs (3.76 [1.89,7.82], P < .01). DISCUSSION While significant reductions in post-discharge AEs were not observed, checklist participants experiencing a post-discharge AE were more likely to report NWS and had a shorter duration of injury. CONCLUSION Interventions designed to prompt patients to report NWS may facilitate earlier detection of AEs after discharge. CLINICALTRIALS.GOV NCT05232656.
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Affiliation(s)
- Anant Vasudevan
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Savanna Plombon
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Mass General Brigham, Boston, MA 02145, United States
| | - Nicholas Piniella
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Alison Garber
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Maria Malik
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Erin O'Fallon
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Abhishek Goyal
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Esteban Gershanik
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Vivek Kumar
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Julie Fiskio
- Mass General Brigham, Boston, MA 02145, United States
| | - Cathy Yoon
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Stuart R Lipsitz
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Jeffrey L Schnipper
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Anuj K Dalal
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
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Schnipper JL, Oreper S, Hubbard CC, Kurbegov D, Egloff SAA, Najafi N, Valdes G, Siddiqui Z, O 'Leary KJ, Horwitz LI, Lee T, Auerbach AD. Analysis of Clinical Criteria for Discharge Among Patients Hospitalized for COVID-19: Development and Validation of a Risk Prediction Model. J Gen Intern Med 2024:10.1007/s11606-024-08856-x. [PMID: 38937368 DOI: 10.1007/s11606-024-08856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Patients hospitalized with COVID-19 can clinically deteriorate after a period of initial stability, making optimal timing of discharge a clinical and operational challenge. OBJECTIVE To determine risks for post-discharge readmission and death among patients hospitalized with COVID-19. DESIGN Multicenter retrospective observational cohort study, 2020-2021, with 30-day follow-up. PARTICIPANTS Adults admitted for care of COVID-19 respiratory disease between March 2, 2020, and February 11, 2021, to one of 180 US hospitals affiliated with the HCA Healthcare system. MAIN MEASURES Readmission to or death at an HCA hospital within 30 days of discharge was assessed. The area under the receiver operating characteristic curve (AUC) was calculated using an internal validation set (33% of the HCA cohort), and external validation was performed using similar data from six academic centers associated with a hospital medicine research network (HOMERuN). KEY RESULTS The final HCA cohort included 62,195 patients (mean age 61.9 years, 51.9% male), of whom 4704 (7.6%) were readmitted or died within 30 days of discharge. Independent risk factors for death or readmission included fever within 72 h of discharge; tachypnea, tachycardia, or lack of improvement in oxygen requirement in the last 24 h; lymphopenia or thrombocytopenia at the time of discharge; being ≤ 7 days since first positive test for SARS-CoV-2; HOSPITAL readmission risk score ≥ 5; and several comorbidities. Inpatient treatment with remdesivir or anticoagulation were associated with lower odds. The model's AUC for the internal validation set was 0.73 (95% CI 0.71-0.74) and 0.66 (95% CI 0.64 to 0.67) for the external validation set. CONCLUSIONS This large retrospective study identified several factors associated with post-discharge readmission or death in models which performed with good discrimination. Patients 7 or fewer days since test positivity and who demonstrate potentially reversible risk factors may benefit from delaying discharge until those risk factors resolve.
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Affiliation(s)
- Jeffrey L Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA.
| | - Sandra Oreper
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA
| | - Colin C Hubbard
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA
| | - Dax Kurbegov
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA
- HCA Healthcare, Sarah Cannon Research Institute (SCRI), Nashville, TN, USA
| | - Shanna A Arnold Egloff
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA
- HCA Healthcare, Sarah Cannon Research Institute (SCRI), Nashville, TN, USA
- HCA Healthcare, HCA Healthcare Research Institute (HRI), Kansas City, MO, USA
| | - Nader Najafi
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA
| | - Gilmer Valdes
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA
| | - Zishan Siddiqui
- Division of Hospital Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin J O 'Leary
- Division of Hospital Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Leora I Horwitz
- Department of Population Health, Department of Medicine, NYU Grossman School of Medicine; Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York City, NY, USA
| | - Tiffany Lee
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
- COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA
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Bryant AD, Robinson TJ, Gutierrez-Perez JT, Manning BL, Glenn K, Imborek KL, Kuperman EF. Outcomes of a home telemonitoring program for SARS-CoV-2 viral infection at a large academic medical center. J Telemed Telecare 2024; 30:675-680. [PMID: 35275502 PMCID: PMC8919094 DOI: 10.1177/1357633x221086067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telemedicine serves as a viable option during the COVID-19 pandemic to provide in-home care, maintain home isolation precautions, reduce unnecessary healthcare exposures, and de-burden hospitals. METHODS We created a novel telemedicine program to closely monitor patients infected with SARS-CoV-2 (COVID-19) at home. Adult patients with COVID-19 were enrolled in the program at the time of documented infection. Patients were followed by a team of providers via telephone or video visits at frequent intervals until resolution of their acute illness. Additionally, patients were stratified into high-risk and low-risk categories based on demographics and underlying comorbidities. The primary outcome was hospitalization after enrollment in the home monitoring program, including 30 days after discharge from the program. RESULTS Over a 3.5-month period, 1128 patients met criteria for enrollment in the home monitoring program. 30.7% were risk stratified as high risk for poor outcomes based on their comorbidities and age. Of the 1128 patients, 6.2% required hospitalization and 1.2% required ICU admission during the outcome period. Hospitalization was more frequent in patients identified as high risk (14.2% vs 2.7%, P < 0.001). DISCUSSION Enrollment in a home monitoring program appears to be an effective and sustainable modality for the ambulatory management of COVID-19.
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Affiliation(s)
- Andrew D Bryant
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Tommy J Robinson
- Internal Medicine Residency, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Bradley L Manning
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Glenn
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Katherine L Imborek
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ethan F Kuperman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Hailu R, Sousa J, Tang M, Mehrotra A, Uscher-Pines L. Challenges and Facilitators in Implementing Remote Patient Monitoring Programs in Primary Care. J Gen Intern Med 2024:10.1007/s11606-023-08557-x. [PMID: 38653884 DOI: 10.1007/s11606-023-08557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/01/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND The COVID-19 pandemic resulted in greater use of remote patient monitoring (RPM). However, the use of RPM has been modest compared to other forms of telehealth. OBJECTIVE To identify and describe barriers to the implementation of RPM among primary care physicians (PCPs) that may be constraining its growth. DESIGN We conducted 20 semi-structured interviews with PCPs across the USA who adopted RPM. Interview questions focused on implementation facilitators and barriers and RPM's impact on quality. We conducted thematic analysis of semi-structured interviews using both inductive and deductive approaches. The analysis was informed by the NASSS (non-adoption and abandonment and challenges to scale-up, spread, and sustainability) framework. PARTICIPANTS PCPs who practiced at least 10 h per week in an outpatient setting, served adults, and monitored blood pressure and/or blood glucose levels with automatic transmission of data with at least 3 patients. KEY RESULTS While PCPs generally agreed that RPM improved quality of care for their patients, many identified barriers to adoption and maintenance of RPM programs. Challenges included difficulties handling the influx of data and establishing a manageable workflow, along with digital and health literacy barriers. In addition to these barriers, many PCPs did not believe RPM was profitable. CONCLUSIONS To encourage ongoing growth of RPM, it will be necessary to address implementation barriers through changes in payment policy, training and education in digital and health literacy, improvements in staff roles and workflows, and new strategies to ensure equitable access.
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Affiliation(s)
- Ruth Hailu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Mitchell Tang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Yang JY, Liao CH, Hung FM, Chu FY, Chiu KM. Transformation from zero tolerance to living with COVID-19 in New Taipei City, Taiwan. Experience of the FEMH "home-hotel-hospital" care model. J Formos Med Assoc 2024; 123 Suppl 1:S39-S46. [PMID: 37500362 PMCID: PMC10285199 DOI: 10.1016/j.jfma.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/29/2023] Open
Abstract
In March 2022, local cases of COVID-19 infections of the Omicron variant were identified in Taiwan. In response to impending community transmission, the "Home-Hotel-Hospital" (3H) care model was implemented by the Far Eastern Memorial Hospital (FEMH). It established the first remote home care center in Taiwan and two quarantine centers in two hotels. The hospital focused on care for critical COVID-19 patients, community screening, and telehealth care. The home care call center evaluated and triaged up to 104,244 cases and provided remote home care for 96,894 cases within the first three months; in 2022, it provided home care to 107,095 patients. The two quarantine hotels admitted a total of 1834 individuals. A total of 3796 COVID-19 patients were admitted to the hospital-367 in intensive care. The telehealth outpatient clinic-including the online video clinic-served 25,775 cases; 21.5% (n = 5544) of them were prescribed oral anti-viral medications. In 2022, the FEMH prescribed oral anti-viral therapies to a total of 12,571 cases. The FEMH 3H care model not only enabled non-critical patients to recover at home, but also provided severely ill patients access to timely in-hospital care. In the future, this model will continue to play a significant role in COVID-19 management.
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Affiliation(s)
- Ju-Yeh Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Center for General Education, Lee-Ming Institute of Technology, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taiwan
| | - Chun-Hsing Liao
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taiwan
| | - Fang-Ming Hung
- Department of Surgical Intensive Care Unit, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Fang-Yeh Chu
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan; School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Kuan-Ming Chiu
- Department of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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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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Kottler J, Khosla S, Recio V, Chestek D, Shanks J, Larimer K, Hoek TV. Evaluating an Advanced Practice Provider-Managed Coronavirus Disease 2019 Deterioration Program. J Nurse Pract 2023; 19:104754. [PMID: 37693741 PMCID: PMC10486239 DOI: 10.1016/j.nurpra.2023.104754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background COVID-19 changed how healthcare systems could provide quality healthcare to patients, safely. An urban healthcare system created an advanced practice provider (APP)-managed continuous remote patient monitoring (cRPM) program. Methods A mixed-method study design focusing on the usable and feasible nature of the cRPM program. Both APP-guided interviews and online questionnaires were analyzed. Results There was overwhelmingly positive APP feedback utilizing the remote monitoring solution including providing quality healthcare, detecting early clinical deterioration, and desiring to adapt the solution to other acute or chronic diseases. Implications Understanding the clinical users' feedback on usability and feasibility of cRPM highlights the significance of rapid clinical assessment, urgent care escalation and provider accessibility.
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Affiliation(s)
- Janey Kottler
- University of Illinois Hospital and Health Sciences, Emergency Department, 1740 W Taylor Street, Chicago, IL 60612
| | - Shaveta Khosla
- University of Illinois Hospital and Health Sciences, Emergency Department, 1740 W Taylor Street, Chicago, IL 60612
| | - Vicki Recio
- University of Illinois Hospital and Health Sciences, Emergency Department, 1740 W Taylor Street, Chicago, IL 60612
| | - David Chestek
- University of Illinois Hospital and Health Sciences, Emergency Department, 1740 W Taylor Street, Chicago, IL 60612
| | - Jacqueline Shanks
- University of Illinois Chicago College of Nursing, 845 S. Damen Avenue, Chicago, IL 60612
| | - Karen Larimer
- physIQ, Chicago, IL, 200 W Jackson Blvd, Suite 550, Chicago, IL 60606
| | - Terry Vanden Hoek
- University of Illinois Hospital and Health Sciences, Emergency Department, 1740 W Taylor Street, Chicago, IL 60612
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10
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DeBolt CL, Rheuban KS, Harris D. Telehealth Services: Improving Equity in Pulmonary Health Outcomes. Clin Chest Med 2023; 44:651-660. [PMID: 37517842 DOI: 10.1016/j.ccm.2023.03.017] [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: 08/01/2023]
Abstract
Expansion of telehealth services has the potential to attenuate health inequities in pulmonary medicine, by improving access to care and health outcomes in patients with lung disease. These telehealth services include remote patient monitoring, synchronous telemedicine, and remote pulmonary rehabilitation. Currently, patients who are White, well-educated, wealthy, and from urban areas are the most likely to benefit from telehealth services. Without clear policy decisions and planning to overcome the "Digital Divide," telehealth services will only exacerbate existing disparities within the pulmonary disease. We describe the benefits and limitations of these new technologies and their impact on improving equity in pulmonary medicine.
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Affiliation(s)
| | - Karen S Rheuban
- Department of Pediatrics, University of Virginia, Center for Telehealth, Charlottesville, VA, USA
| | - Drew Harris
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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11
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Joyce D, De Brún A, Symmons SM, Fox R, McAuliffe E. Remote patient monitoring for COVID-19 patients: comparisons and framework for reporting. BMC Health Serv Res 2023; 23:826. [PMID: 37537615 PMCID: PMC10401771 DOI: 10.1186/s12913-023-09526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/09/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND COVID-19 has challenged health services throughout the world in terms of hospital capacity and put staff and vulnerable populations at risk of infection. In the face of these challenges, many health providers have implemented remote patient monitoring (RPM) of COVID-19 patients in their own homes. However systematic reviews of the literature on these implementations have revealed wide variations in how RPM is implemented; along with variations in particulars of RPM reported on, making comparison and evaluation difficult. A review of reported items is warranted to develop a framework of key items to enhance reporting consistency. The aims of this review of remote monitoring for COVID-19 patients are twofold: (1) to facilitate comparison between RPM implementations by tabulating information and values under common domains. (2) to develop a reporting framework to enhance reporting consistency. METHOD A review of the literature for RPM for COVID-19 patients was conducted following PRISMA guidelines. The Medline database was searched for articles published between 2020 to February 2023 and studies reporting on items with sufficient detail to compare one with another were included. Relevant data was extracted and synthesized by the lead author. Quality appraisal was not conducted as the the articles considered were evaluated as informational reports of clinical implementations rather than as studies designed to answer a research question. RESULTS From 305 studies retrieved, 23 studies were included in the review: fourteen from the US, two from the UK and one each from Africa, Ireland, China, the Netherlands, Belgium, Australia and Italy. Sixteen generally reported items were identified, shown with the percentage of studies reporting in brackets: Reporting Period (82%), Rationale (100%), Patients (100%), Medical Team (91%) Provider / Infrastructure (91%), Communications Platform (100%), Patient Equipment (100%), Training (48%), Markers (96%), Frequency of prompt / Input (96%),Thresholds (82%), Discharge (61%), Enrolled (96%), Alerts/Escalated (78%), Patient acceptance (43%), and Patient Adherence (52%). Whilst some studies reported on patient training and acceptance, just one reported on staff training and none on staff acceptance. CONCLUSIONS Variations in reported items were found. Pending the establishment of a robust set of reporting guidelines, we propose a reporting framework consisting of eighteen reporting items under the following four domains: Context, Technology, Process and Metrics.
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Affiliation(s)
- David Joyce
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Aoife De Brún
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Sophie Mulcahy Symmons
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Robert Fox
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Eilish McAuliffe
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland.
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12
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Thompson JA, Hersch D, Miner MH, Melnik TE, Adam P. Remote Patient Monitoring for COVID-19: A Retrospective Study on Health Care Utilization. Telemed J E Health 2023; 29:1179-1185. [PMID: 36706034 PMCID: PMC10440676 DOI: 10.1089/tmj.2022.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction: Data are limited on the effectiveness of remote patient monitoring (RPM) for acute illnesses, including COVID-19. We conducted a study to determine if enrollment in a COVID-19 RPM program was associated with better outcomes. Methods: From March through September 2020, patients with respiratory symptoms and presumptive COVID-19 were referred to the health system's COVID-19 RPM program. We conducted a retrospective cohort study comparing outcomes for patients enrolled in the RPM (n = 4,435) with those who declined enrollment (n = 2,742). Primary outcomes were emergency room, hospital, and intensive care unit admissions, and death. We used logistic regression to adjust for demographic differences and known risk factors for severe COVID-19. Results: Patients enrolled in the RPM were less likely to have risk factors for severe COVID-19. There was a significant decrease in the odds of death for the group enrolled in the RPM (adjusted odds ratio [OR] = 0.50; 95% confidence interval [CI], 0.30-0.83) and a nonsignificant decrease in the odds of the other primary outcomes. Increased number of interactions with the RPM significantly decreased the odds of hospital admission (OR = 0.92; 95% CI, 0.88-0.95). Conclusions: COVID-19 RPM enrollment was associated with decreased odds of death, and the more patients interacted with the RPM, the less likely they were to require hospital admission. RPM is a promising tool that has the potential to improve patient outcomes for acute illness, but controlled trials are necessary to confirm these findings.
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Affiliation(s)
- Joshua A. Thompson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Derek Hersch
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael H. Miner
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Tanya E. Melnik
- Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Patricia Adam
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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13
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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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14
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Beaney T, Clarke J, Alboksmaty A, Flott K, Fowler A, Benger J, Aylin PP, Elkin S, Darzi A, Neves AL. Evaluating the impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in patients with COVID-19 assessed in emergency departments in England: a retrospective matched cohort study. Emerg Med J 2023; 40:460-465. [PMID: 36854617 PMCID: PMC10313966 DOI: 10.1136/emermed-2022-212377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/21/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND To identify the impact of enrolment onto a national pulse oximetry remote monitoring programme for COVID-19 (COVID-19 Oximetry @home; CO@h) on health service use and mortality in patients attending Emergency Departments (EDs). METHODS We conducted a retrospective matched cohort study of patients enrolled onto the CO@h pathway from EDs in England. We included all patients with a positive COVID-19 test from 1 October 2020 to 3 May 2021 who attended ED from 3 days before to 10 days after the date of the test. All patients who were admitted or died on the same or following day to the first ED attendance within the time window were excluded. In the primary analysis, participants enrolled onto CO@h were matched using demographic and clinical criteria to participants who were not enrolled. Five outcome measures were examined within 28 days of first ED attendance: (1) Death from any cause; (2) Any subsequent ED attendance; (3) Any emergency hospital admission; (4) Critical care admission; and (5) Length of stay. RESULTS 15 621 participants were included in the primary analysis, of whom 639 were enrolled onto CO@h and 14 982 were controls. Odds of death were 52% lower in those enrolled (95% CI 7% to 75%) compared with those not enrolled onto CO@h. Odds of any ED attendance or admission were 37% (95% CI 16% to 63%) and 59% (95% CI 32% to 91%) higher, respectively, in those enrolled. Of those admitted, those enrolled had 53% (95% CI 7% to 76%) lower odds of critical care admission. There was no significant impact on length of stay. CONCLUSIONS These findings indicate that for patients assessed in ED, pulse oximetry remote monitoring may be a clinically effective and safe model for early detection of hypoxia and escalation. However, possible selection biases might limit the generalisability to other populations.
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Affiliation(s)
- Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Jonathan Clarke
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Mathematics, Imperial College London, London, UK
| | - Ahmed Alboksmaty
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Kelsey Flott
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Paul P Aylin
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sarah Elkin
- Imperial College Healthcare NHS Trust, London, UK
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
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15
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Persell SD, Petito LC, Anthony L, Peprah Y, Lee JY, Campanella T, Campbell J, Pigott K, Kadric J, Duax CJ, Li J, Sato H. Prospective Cohort Study of Remote Patient Monitoring with and without Care Coordination for Hypertension in Primary Care. Appl Clin Inform 2023; 14:428-438. [PMID: 36933552 PMCID: PMC10232212 DOI: 10.1055/a-2057-7277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/11/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Out-of-office blood pressure (BP) measurements contribute valuable information for guiding clinical management of hypertension. Measurements from home devices can be directly transmitted to patients' electronic health record for use in remote monitoring programs. OBJECTIVE This study aimed to compare in primary care practice care coordinator-assisted implementation of remote patient monitoring (RPM) for hypertension to RPM implementation alone and to usual care. METHODS This was a pragmatic observational cohort study. Patients aged 65 to 85 years with Medicare insurance from two populations were included: those with uncontrolled hypertension and a general hypertension group seeing primary care physicians (PCPs) within one health system. Exposures were clinic-level availability of RPM plus care coordination, RPM alone, or usual care. At two clinics (13 PCPs), nurse care coordinators with PCP approval offered RPM to patients with uncontrolled office BP and assisted with initiation. At two clinics (39 PCPs), RPM was at PCPs' discretion. Twenty clinics continued usual care. Main measures were controlling high BP (<140/90 mm Hg), last office systolic blood pressure (SBP), and proportion with antihypertensive medication intensification. RESULTS Among the Medicare cohorts with uncontrolled hypertension, 16.7% (39/234) of patients from the care coordination clinics were prescribed RPM versus <1% (4/600) at noncare coordination sites. RPM-enrolled care coordination group patients had higher baseline SBP than the noncare coordination group (148.8 vs. 140.0 mm Hg). After 6 months, in the uncontrolled hypertension cohorts the prevalences of controlling high BP were 32.5% (RPM with care coordination), 30.7 % (RPM alone), and 27.1% (usual care); multivariable adjusted odds ratios (95% confidence interval) were 1.63 (1.12-2.39; p = 0.011) and 1.29 (0.98-1.69; p = 0.068) compared with usual care, respectively. CONCLUSION Care coordination facilitated RPM enrollment among poorly controlled hypertension patients and may improve hypertension control in primary care among Medicare patients.
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Affiliation(s)
- Stephen D. Persell
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Lucia C. Petito
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Lauren Anthony
- Department of Quality and Patient Safety, Northwestern Medical Group, Northwestern Memorial Healthcare, Chicago, Illinois, United States
| | - Yaw Peprah
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Ji Young Lee
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Tara Campanella
- Department of Ambulatory Care Coordination, Northwestern Memorial Healthcare, Chicago, Illinois, United States
| | - Jill Campbell
- Department of Ambulatory Care Coordination, Northwestern Memorial Healthcare, Chicago, Illinois, United States
| | - Kelly Pigott
- Department of Ambulatory Care Coordination, Northwestern Memorial Healthcare, Chicago, Illinois, United States
| | - Jasmina Kadric
- Department of Ambulatory Care Coordination, Northwestern Memorial Healthcare, Chicago, Illinois, United States
| | | | - Jim Li
- Department of Global Medical Affairs, Omron Healthcare Co. Ltd, Kyoto, Japan
| | - Hironori Sato
- Product Innovation Department, Technology Development HQ, Omron Healthcare Co. Ltd, Kyoto, Japan
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16
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Belzile MN, Lam P, Chan AK, Andany N, Simor A, Estrada-Codecido J, Ga'al A, Kapsack A, Mahmud A, Fridman D, Lee SM, Santoro A, Vandenbergh N, Daneman N. Evaluating the impact of a virtual outpatient care program in preventing hospitalizations, emergency department visits and mortality for patients with COVID-19: a matched cohort study. Clin Microbiol Infect 2023:S1198-743X(23)00154-4. [PMID: 37059224 PMCID: PMC10091723 DOI: 10.1016/j.cmi.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES We sought to evaluate the impact of virtual care in preventing unnecessary healthcare visits for SARSCoV-2 patients. METHODS We conducted a retrospective matched cohort study, evaluating the COVID-19 Expansion to Outpatients (COVIDEO) program involving virtual assessments for all positive patients in the Sunnybrook assessment center from January 2020 to June 2021, followed by risk-stratified routine follow-up, couriering of oxygen saturation devices, and 24 hour/day direct-to-physician pager for urgent questions. We linked COVIDEO data to province-wide datasets, matching each eligible COVIDEO patient to ≤10 other Ontario SARS-CoV-2 patients on age, sex, neighborhood, and date. The primary outcome was emergency department (ED) visit, hospitalization or death within 30 days. Multivariable regression accounted for comorbidities, vaccination and pre-pandemic healthcare utilization. RESULTS Among 6,508 eligible COVIDEO patients, 4,763 (73.1%) were matched to ≥1 non-COVIDEO patient. COVIDEO care was protective against the primary composite outcome (adjusted odds ratio (aOR) 0.91, 95%CI 0.82-1.02), with a reduction in ED visits (7.8% vs 9.6%; aOR 0.79, 95%CI 0.70-0.89), but increase in hospitalizations (3.8% vs 2.7%, aOR 1.37, 95%CI 1.14-1.63) reflecting more direct-to-ward admissions (1.3% vs 0.2%, p < 0.0001). Results were similar when matched comparators were limited to patients who had not received virtual care elsewhere with a decrease in ED visits (7.8 vs. 8.6%, aOR 0.86, 95%CI 0.75-0.99) and an increase in hospitalizations (3.7 vs 2.4%, aOR 1.45, 95%CI 1.17-1.80). CONCLUSIONS An intensive remote care program can prevent unnecessary ED visits and facilitate direct-to-ward hospitalizations and thereby mitigate the impact of COVID-19 on the healthcare system.
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Affiliation(s)
- Mei-Ni Belzile
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Philip Lam
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adrienne K Chan
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Nisha Andany
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Simor
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jose Estrada-Codecido
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amal Ga'al
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Abby Kapsack
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Abdalla Mahmud
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel Fridman
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Samantha M Lee
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Aimee Santoro
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nancy Vandenbergh
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nick Daneman
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada.
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17
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Martinez JA, Ehsan A, Mellady M, Goldberg L, Martinez RA. Hospital Days Reduced for Moderate and Severe COVID-19 Patients Through a Home Monitoring Program With Oxygen. Clin Nurs Res 2023; 32:601-607. [PMID: 36760006 PMCID: PMC9975290 DOI: 10.1177/10547738231155298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
While the COVID-19 pandemic continues to strain the healthcare system, it has also expanded telemedicine. There is a subset of hospitalized moderate to severe COVID-19 patients requiring oxygen but no other intervention. This is a retrospective study of patients ≥18 years with moderate to severe COVID-19 that participated in a home monitoring program with supplemental oxygen (HMP-O2) (N = 25). For study outcomes, HMP-O2 participants were compared to patients meeting the same inclusion criteria but did not participate in the program (N = 60). On average, the HMP-O2 patients spent 5.8 days (±5.5 days) in the hospital compared to 8.12 days (±5.5 days) for non-program patients. This resulted in 19% cost-savings for HMP-O2 patients. Lessons learned from this program can be applied to future HMPs for either COVID-19 or other conditions that would benefit from telecare.
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Affiliation(s)
- Jessica A. Martinez
- Department of Nutritional Sciences, The
University of Arizona, Tucson, USA,University of Arizona Cancer Center,
Tucson, USA,Jessica A. Martinez, Department of
Nutritional Sciences, The University of Arizona, 1177 E 4th Street, Tucson, AZ
85719, USA.
| | - Ariana Ehsan
- Tucson Medical Education Program and
TMC HealthCare, AZ, USA
| | | | | | - Ryan A. Martinez
- Department of Nutritional Sciences, The
University of Arizona, Tucson, USA,Tucson Medical Center, AZ, USA
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18
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Ko SQ, Kumar SK, Jacob J, Hooi BMY, Soo M, Nashi N, Cruz MTD, Wah YA, Xin WZ, Smitasin N, Lum L, Archuleta S. Technology-enabled virtual ward for COVID management of the elderly and immunocompromised in Singapore: a descriptive cohort. BMC Infect Dis 2023; 23:102. [PMID: 36809977 PMCID: PMC9942066 DOI: 10.1186/s12879-023-08040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND To address the hospital bed demand for Delta and Omicron surges in Singapore, the National University Health System (NUHS) developed a COVID Virtual Ward to relieve bed pressures on its three acute hospitals-National University Hospital, Ng Teng Fong General Hospital, Alexandra Hospital. To serve a multilingual population, the COVID Virtual Ward featuring protocolized teleconsultation of high-risk patients, use of a vital signs chatbot, supplemented by home visits where necessary. This study aims to evaluate the safety, outcomes and utilisation of the Virtual Ward as a scalable response to COVID-19 surges. METHODS This is a retrospective cohort study of all patients admitted to the COVID Virtual Ward between 23 September to 9 November 2021. Patients were defined as "early discharge" if they were referred from inpatient COVID-19 wards and "admission avoidance" if they were referred directly from primary care or emergency services. Patient demographics, utilisation measures and clinical outcomes were extracted from the electronic health record system. The primary outcomes were escalation to hospital and mortality. Use of the vital signs chatbot was evaluated by examining compliance levels, need for automated reminders and alerts triggered. Patient experience was evaluated using data extracted from a quality improvement feedback form. RESULTS 238 patients were admitted to the COVID Virtual Ward from 23 September to 9 November, of whom 42% were male, 67.6% of Chinese ethnicity. 43.7% were over the age of 70, 20.5% were immunocompromised, and 36.6% were not fully vaccinated. 17.2% of patients were escalated to hospital and 2.1% of patients died. Patients who were escalated to hospital were more likely to be immunocompromised or to have a higher ISARIC 4C-Mortality Score. There were no missed deteriorations. All patients received teleconsults (median of 5 teleconsults per patient, IQR 3-7). 21.4% of patients received home visits. 77.7% of patients engaged with the vital signs chatbot, with a compliance rate of 84%. All patients would recommend the programme to others in their situation. CONCLUSIONS Virtual Wards are a scalable, safe and patient-centered strategy to care for high risk COVID-19 patients at home. TRIAL REGISTRATION NA.
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Affiliation(s)
- Stephanie Q. Ko
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Shoban Krishna Kumar
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Jonathan Jacob
- Department of Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore, 159964 Singapore
| | - Benjamin M. Y. Hooi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Michelle Soo
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Norshima Nashi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Maria Teresa D. Cruz
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Yeo Ai Wah
- Regional Health Service, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Wong Zhi Xin
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Nares Smitasin
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Lionel Lum
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Sophia Archuleta
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
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19
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Abstract
PURPOSE OF REVIEW Home oxygen monitoring and therapy have been increasingly used in the management of patients with chronic diseases. The COVID-19 pandemic has prompted the rapid uptake of remote monitoring programmes to support people with COVID-19 at home. This review discusses the recent evidence and learning in home oxygen monitoring and therapy from the pandemic. RECENT FINDINGS Many home oxygen monitoring programmes were established around the world during the pandemic, mostly in high-income countries to support early detection of hypoxaemia and/or early hospital discharge. The characteristics of these programmes vary widely in the type of monitoring (self-monitoring or clinician-monitoring) and the patient risk groups targeted. There is a lack of evidence for benefits on clinical outcomes, including mortality, and on reductions in healthcare utilisation or cost-effectiveness, but programmes are viewed positively by patients. Recent studies have highlighted the potential bias in pulse oximetry in people with darker skin. SUMMARY Recent evidence indicates that home oxygen monitoring therapy programmes are feasible in acute disease, but further research is needed to establish whether they improve patient outcomes, are cost-effective and to understand their equity impact.
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Affiliation(s)
| | - Jonathan Clarke
- Department of Mathematics, Imperial College London, London, UK
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20
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Doheny EP, O'Callaghan BP, Fahed VS, Liegey J, Goulding C, Ryan S, Lowery MM. Estimation of respiratory rate and exhale duration using audio signals recorded by smartphone microphones. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Sanchez T, Mavragani A, Lee C, Kim Y, Bae YS, Chie EK. The Association of Acute Signs and Symptoms of COVID-19 and Exacerbation of Depression and Anxiety in Patients With Clinically Mild COVID-19: Retrospective Observational Study. JMIR Public Health Surveill 2023; 9:e43003. [PMID: 36645439 PMCID: PMC9926346 DOI: 10.2196/43003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To date, the association between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety in patients with clinically mild COVID-19 has not been evaluated. OBJECTIVE This study was designed to assess the correlation between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety in patients with clinically mild COVID-19 at a residential treatment center in South Korea. METHODS This retrospective study assessed 2671 patients with COVID-19 admitted to 4 residential treatment centers operated by Seoul National University Hospital, South Korea, from March 2020 to April 2022. Depression and anxiety were assessed using the 2-item Patient Health Questionnaire (PHQ-2) and 2-item Generalized Anxiety Disorder (GAD-2) scale, respectively. The exacerbation of depression and anxiety symptoms was identified from the differences in PHQ-2 and GAD-2 scores between admission and discharge, respectively. The patients' clinical characteristics, including acute signs and symptoms of COVID-19, GAD-2 and PHQ-2 scores, were obtained from electronic health records. Demographic characteristics, a summary of vital signs, and COVID-19 symptoms were analyzed and compared between the patient groups with and those without exacerbated PHQ-2 and GAD-2 scores using the chi-square test. We applied logistic regression to identify the association between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety. RESULTS Sleep disorders were associated with exacerbated depression (odds ratio [OR] 1.09, 95% CI 1.05-1.13) and anxiety (OR 1.1, 95% CI 1.06-1.14), and the sore throat symptom was associated with exacerbated anxiety symptoms (OR 1.03, 95% CI 1.00-1.07). Patients with abnormal oxygen saturation during quarantine were more likely to have exacerbated depression (OR 1.27, 95% CI 1.00-1.62), and those with an abnormal body temperature during quarantine were more likely to experience anxiety (OR 1.08, 95% CI 1.01-1.16). As anticipated, patients who experienced psychological symptoms at admission were more likely to experience depression (OR 1.91, 95% CI 1.52-2.41) and anxiety (OR 1.98, 95% CI 1.54-2.53). Meanwhile, the PHQ-2 and GAD-2 scores measured at admission revealed that lower the score, higher the possibility of exacerbation of both depression (OR 0.15, 95% CI 0.11-0.22) and anxiety (OR 0.13, 95% CI 0.10-0.19). CONCLUSIONS Results from this study suggest the importance of further interventions for patients with abnormal oxygen saturation, abnormal body temperatures, sore throat, and sleep disorder symptoms or initial psychological symptoms to mitigate the exacerbation of depression and anxiety. In addition, this study highlights the usability of short and efficient scales such as the PHQ-2 and GAD-2 in the assessment of the mental health of patients with clinically mild COVID-19 symptoms who were quarantined at home during the pandemic era.
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Affiliation(s)
| | | | - Changwoo Lee
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea
| | - Youlim Kim
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ye Seul Bae
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eui Kyu Chie
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, College of Medicine, Seoul National University, Seoul, Republic of Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
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22
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Doheny EP, Flood M, Ryan S, McCarthy C, O'Carroll O, O'Seaghdha C, Mallon PW, Feeney ER, Keatings VM, Wilson M, Kennedy N, Gannon A, Edwards C, Lowery MM. Prediction of low pulse oxygen saturation in COVID-19 using remote monitoring post hospital discharge. Int J Med Inform 2023; 169:104911. [PMID: 36347139 PMCID: PMC9625852 DOI: 10.1016/j.ijmedinf.2022.104911] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Monitoring systems have been developed during the COVID-19 pandemic enabling clinicians to remotely monitor physiological measures including pulse oxygen saturation (SpO2), heart rate (HR), and breathlessness in patients after discharge from hospital. These data may be leveraged to understand how symptoms vary over time in COVID-19 patients. There is also potential to use remote monitoring systems to predict clinical deterioration allowing early identification of patients in need of intervention. METHODS A remote monitoring system was used to monitor 209 patients diagnosed with COVID-19 in the period following hospital discharge. This system consisted of a patient-facing app paired with a Bluetooth-enabled pulse oximeter (measuring SpO2 and HR) linked to a secure portal where data were available for clinical review. Breathlessness score was entered manually to the app. Clinical teams were alerted automatically when SpO2 < 94 %. In this study, data recorded during the initial ten days of monitoring were retrospectively examined, and a random forest model was developed to predict SpO2 < 94 % on a given day using SpO2 and HR data from the two previous days and day of discharge. RESULTS Over the 10-day monitoring period, mean SpO2 and HR increased significantly, while breathlessness decreased. The coefficient of variation in SpO2, HR and breathlessness also decreased over the monitoring period. The model predicted SpO2 alerts (SpO2 < 94 %) with a mean cross-validated. sensitivity of 66 ± 18.57 %, specificity of 88.31 ± 10.97 % and area under the receiver operating characteristic of 0.80 ± 0.11. Patient age and sex were not significantly associated with the occurrence of asymptomatic SpO2 alerts. CONCLUSION Results indicate that SpO2 alerts (SpO2 < 94 %) on a given day can be predicted using SpO2 and heart rate data captured on the two preceding days via remote monitoring. The methods presented may help early identification of patients with COVID-19 at risk of clinical deterioration using remote monitoring.
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Affiliation(s)
- Emer P. Doheny
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland,Corresponding author
| | - Matthew Flood
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | - Silke Ryan
- School of Medicine, University College Dublin, Dublin, Ireland,St. Vincent’s University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- School of Medicine, University College Dublin, Dublin, Ireland,St. Vincent’s University Hospital, Dublin, Ireland
| | | | | | | | - Eoin R. Feeney
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | - Avril Gannon
- Midland Regional Hospital at Tullamore, Tullamore, Ireland
| | | | - Madeleine M. Lowery
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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23
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Coffey JD, Christopherson LA, Williams RD, Gathje SR, Bell SJ, Pahl DF, Manka L, Blegen RN, Maniaci MJ, Ommen SR, Haddad TC. Development and implementation of a nurse-based remote patient monitoring program for ambulatory disease management. Front Digit Health 2022; 4:1052408. [PMID: 36588748 PMCID: PMC9794766 DOI: 10.3389/fdgth.2022.1052408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Numerous factors are intersecting in healthcare resulting in an increased focus on new tools and methods for managing care in patients' homes. Remote patient monitoring (RPM) is an option to provide care at home and maintain a connection between patients and providers to address ongoing medical issues. Methods Mayo Clinic developed a nurse-led RPM program for disease and post-procedural management to improve patient experience, clinical outcomes, and reduce health care utilization by more directly engaging patients in their health care. Enrolled patients are sent a technology package that includes a digital tablet and peripheral devices for the collection of symptoms and vital signs. The data are transmitted from to a hub integrated within the electronic health record. Care team members coordinate patient needs, respond to vital sign alerts, and utilize the data to inform and provide individualized patient assessment, patient education, medication management, goal setting, and clinical care planning. Results Since its inception, the RPM program has supported nearly 22,000 patients across 17 programs. Patients who engaged in the COVID-19 RPM program experienced a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization >7 days (3.5% vs. 6.7%, P = 0.001), intensive care unit (ICU) admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those enrolled and unengaged with the technology. Patients with chronic conditions who were monitored with RPM upon hospital discharge were significantly less likely to experience 30-day readmissions (18.2% vs. 23.7%, P = 0.03) compared with those unmonitored. Ninety-five percent of patients strongly agreed or agreed they were likely to recommend RPM to a friend or family member. Conclusions The Mayo Clinic RPM program has generated positive clinical outcomes and is satisfying for patients. As technology advances, there are greater opportunities to enhance this clinical care model and it should be extended and expanded to support patients across a broader spectrum of needs. This report can serve as a framework for health care organizations to implement and enhance their RPM programs in addition to identifying areas for further evolution and exploration in developing RPM programs of the future.
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Affiliation(s)
- Jordan D. Coffey
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Correspondence: Jordan D. Coffey
| | | | - Ryan D. Williams
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Integrity & Compliance Office, Mayo Clinic, Rochester, MN, United States
| | - Shelby R. Gathje
- Research Administrative Services, Mayo Clinic, Rochester, MN, United States
| | - Sarah J. Bell
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Dominick F. Pahl
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Lukas Manka
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - R. Nicole Blegen
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Michael J. Maniaci
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Steve R. Ommen
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Tufia C. Haddad
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Oncology, Mayo Clinic, Rochester, MN, United States
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24
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Azevedo S, Guede-Fernández F, von Hafe F, Dias P, Lopes I, Cardoso N, Coelho P, Santos J, Fragata J, Vital C, Semedo H, Gualdino A, Londral A. Scaling-up digital follow-up care services: collaborative development and implementation of Remote Patient Monitoring pilot initiatives to increase access to follow-up care. Front Digit Health 2022; 4:1006447. [PMID: 36569802 PMCID: PMC9768029 DOI: 10.3389/fdgth.2022.1006447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background COVID-19 increased the demand for Remote Patient Monitoring (RPM) services as a rapid solution for safe patient follow-up in a lockdown context. Time and resource constraints resulted in unplanned scaled-up RPM pilot initiatives posing risks to the access and quality of care. Scalability and rapid implementation of RPM services require social change and active collaboration between stakeholders. Therefore, a participatory action research (PAR) approach is needed to support the collaborative development of the technological component while simultaneously implementing and evaluating the RPM service through critical action-reflection cycles. Objective This study aims to demonstrate how PAR can be used to guide the scalability design of RPM pilot initiatives and the implementation of RPM-based follow-up services. Methods Using a case study strategy, we described the PAR team's (nurses, physicians, developers, and researchers) activities within and across the four phases of the research process (problem definition, planning, action, and reflection). Team meetings were analyzed through content analysis and descriptive statistics. The PAR team selected ex-ante pilot initiatives to reflect upon features feedback and participatory level assessment. Pilot initiatives were investigated using semi-structured interviews transcribed and coded into themes following the principles of grounded theory and pilot meetings minutes and reports through content analysis. The PAR team used the MoSCoW prioritization method to define the set of features and descriptive statistics to reflect on the performance of the PAR approach. Results The approach involved two action-reflection cycles. From the 15 features identified, the team classified 11 as must-haves in the scaled-up version. The participation was similar among researchers (52.9%), developers (47.5%), and physicians (46.7%), who focused on suggesting and planning actions. Nurses with the lowest participation (5.8%) focused on knowledge sharing and generation. The top three meeting outcomes were: improved research and development system (35.0%), socio-technical-economic constraints characterization (25.2%), and understanding of end-user technology utilization (22.0%). Conclusion The scalability and implementation of RPM services must consider contextual factors, such as individuals' and organizations' interests and needs. The PAR approach supports simultaneously designing, developing, testing, and evaluating the RPM technological features, in a real-world context, with the participation of healthcare professionals, developers, and researchers.
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Affiliation(s)
- Salomé Azevedo
- Value for Health CoLAB, Lisbon, Portugal,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal,CEG-IST, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - Federico Guede-Fernández
- Value for Health CoLAB, Lisbon, Portugal,LIBPhys (Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics), NOVA School of Science and Technology, Campus de Caparica, Caparica, Portugal
| | - Francisco von Hafe
- Value for Health CoLAB, Lisbon, Portugal,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Pedro Dias
- Value for Health CoLAB, Lisbon, Portugal,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Inês Lopes
- Fraunhofer Portugal AICOS, Porto, Portugal
| | | | - Pedro Coelho
- Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal,Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Jorge Santos
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - José Fragata
- Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal,Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Clara Vital
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Helena Semedo
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Gualdino
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Londral
- Value for Health CoLAB, Lisbon, Portugal,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal,Correspondence: Ana Londral
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25
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Haddad TC, Coffey JD, Deng Y, Glasgow AE, Christopherson LA, Sangaralingham LR, Bell SJ, Shah VP, Pritchett JC, Orenstein R, Speicher LL, Maniaci MJ, Ganesh R, Borah BJ. Impact of a High-Risk, Ambulatory COVID-19 Remote Patient Monitoring Program on Utilization, Cost, and Mortality. Mayo Clin Proc 2022; 97:2215-2225. [PMID: 36464463 PMCID: PMC9444887 DOI: 10.1016/j.mayocp.2022.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate care utilization, cost, and mortality among high-risk patients enrolled in a coronavirus disease 2019 (COVID-19) remote patient monitoring (RPM) program. METHODS This retrospective analysis included patients diagnosed with COVID-19 at risk for severe disease who enrolled in the RPM program between March 2020 and October 2021. The program included in-home technology for symptom and physiologic data monitoring with centralized care management. Propensity score matching established matched cohorts of RPM-engaged (defined as ≥1 RPM technology interactions) and non-engaged patients using a logistic regression model of 59 baseline characteristics. Billing codes and the electronic death certificate system were used for data abstraction from the electronic health record and reporting of care utilization and mortality endpoints. RESULTS Among 5796 RPM-enrolled patients, 80.0% engaged with the technology. Following matching, 1128 pairs of RPM-engaged and non-engaged patients comprised the analysis cohorts. Mean patient age was 63.3 years, 50.9% of patients were female, and 81.9% were non-Hispanic White. Patients who were RPM-engaged experienced significantly lower rates of 30-day, all-cause hospitalization (13.7% vs 18.0%, P=.01), prolonged hospitalization (3.5% vs 6.7%, P=.001), intensive care unit admission (2.3% vs 4.2%, P=.01), and mortality (0.5% vs 1.7%; odds ratio, 0.31; 95% CI, 0.12 to 0.78; P=.01), as well as cost of care ($2306.33 USD vs $3565.97 USD, P=0.04), than those enrolled in RPM but non-engaged. CONCLUSION High-risk COVID-19 patients enrolled and engaged in an RPM program experienced lower rates of hospitalization, intensive care unit admission, mortality, and cost than those enrolled and non-engaged. These findings translate to improved hospital bed access and patient outcomes.
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Affiliation(s)
- Tufia C Haddad
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA; Department of Oncology, Mayo Clinic, Rochester, MN, USA.
| | | | - Yihong Deng
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Amy E Glasgow
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Sarah J Bell
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA; Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - Vishal P Shah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joshua C Pritchett
- Department of Oncology, Mayo Clinic, Rochester, MN, USA; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Michael J Maniaci
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Bijan J Borah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Science, Mayo Clinic, Rochester, MN, USA
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26
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Frontline Physician Perspectives on Their Experiences Working During the First Wave of the COVID-19 Pandemic. J Gen Intern Med 2022; 37:4233-4240. [PMID: 36123437 PMCID: PMC9484839 DOI: 10.1007/s11606-022-07792-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/06/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic physicians worked on the front lines, immersed in uncertainty. Research into perspectives of frontline physicians has lagged behind clinical innovation throughout the pandemic. OBJECTIVE To inform ongoing and future efforts in the COVID-19 pandemic, we conducted a qualitative exploration of physician perspectives of the effects of policies and procedures as well as lessons learned while caring for patients during the height of the first wave in the spring of 2020. DESIGN A confidential survey was emailed to a convenience sample. Survey questions included demographic data, participant role in the pandemic, and geographic location. Eleven open-ended questions explored their perspectives and advice they would give going forward. Broad areas covered included COVID-19-specific education, discharge planning, unintended consequences for patient care, mental health conditions to anticipate, and personal/institutional factors influencing workforce well-being amid the crisis. PARTICIPANTS We received fifty-five surveys from May through July 2020. Demographic data demonstrated sampling of frontline physicians working in various epicenters in the USA, and diversity in gender, race/ethnicity, and clinical specialty. APPROACH Inductive thematic analysis. KEY RESULTS Four themes emerged through data analysis: (1) Leadership can make or break morale; (2) Leadership should engage frontline workers throughout decision-making processes; (3) Novelty of COVID-19 led to unintended consequences in care delivery; and (4) Mental health sequelae will be profound and pervasive. CONCLUSIONS Our participants demonstrated the benefit of engaging frontline physicians as important stakeholders in policy generation, evaluation, and revision; they highlighted challenges, successes, unintended consequences, and lessons learned from various epicenters in the first wave of the COVID-19 pandemic. There is much to be learned from the early COVID-19 pandemic crisis; our participants' insights elucidate opportunities to examine institutional performance, effect policy change, and improve crisis management in order to better prepare for this and future pandemics.
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27
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Eichler S, Carnarius S, Steiger E, von Stillfried D. Interrupting chains of respiratory infections via remote patient monitoring in ambulatory care - a randomized controlled trial during the 2020/21 infection season. DIALOGUES IN HEALTH 2022; 1:100021. [PMID: 38515879 PMCID: PMC10953948 DOI: 10.1016/j.dialog.2022.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 03/23/2024]
Abstract
Aim of the study The aim of the study was to investigate patient satisfaction, saving of time and the possible reduction of visits to medical practices that use Remote Patient Monitoring (RPM) during treatment compared to usual care. Methods In a randomized controlled trial between October 2020 and May 2021, the participating medical practices were randomized into three groups (two different RPM systems, one control). Doctors were required to enroll patients ≥18 years with acute respiratory infection in possession of a web-enabled device, such as a laptop, tablet or computer. After a three-month study phase, doctors were asked to describe the treatment of their patients via online survey. Patients were also questioned. The analysis was carried out descriptively and through group comparisons. Results 51 practices with 121 patients were included. Overall, the results generally show a positive assessment of digital care on the patient side. As for the doctors, handling and integrating the systems into established practice routines seem to be a challenge. Further, the number of patient visits to the medical practice was not reduced by using the systems. Doctors did not save time, but the relationship to the patients was intensified. Conclusion While there was no indication for an increase in efficiency by using RPM systems, participating doctors indicated their potential for an enhanced interaction between doctor and patient. In particular, intensified interaction contact with patients with chronic diseases (e. g. COPD, long-COVID) could be of long-term interest and importance for doctors in ambulatory care.Trial Registration: DRKS00023553.
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Affiliation(s)
- Sarah Eichler
- Central Research Institute of Ambulatory Health Care in Germany, Germany
| | | | - Edgar Steiger
- Central Research Institute of Ambulatory Health Care in Germany, Germany
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28
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Duggan NM, Jowkar N, Ma IWY, Schulwolf S, Selame LA, Fischetti CE, Kapur T, Goldsmith AJ. Novice-performed point-of-care ultrasound for home-based imaging. Sci Rep 2022; 12:20461. [PMID: 36443355 PMCID: PMC9703400 DOI: 10.1038/s41598-022-24513-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
Patient-performed point-of-care ultrasound (POCUS) may be feasible for use in home-based healthcare. We investigated whether novice users can obtain lung ultrasound (LUS) images via self-scanning with similar interpretability and quality as experts. Adult participants with no prior medical or POCUS training, who were capable of viewing PowerPoint slides in their home and who could hold a probe to their chest were recruited. After training, volunteers self-performed 8-zone LUS and saved images using a hand-held POCUS device in their own home. Each 8-zone LUS scan was repeated by POCUS experts. Clips were independently viewed and scored by POCUS experts blinded to performing sonographers. Quality and interpretability scores of novice- and expert-obtained LUS images were compared. Thirty volunteers with average age of 42.8 years (Standard Deviation (SD) 15.8), and average body mass index of 23.7 (SD 3.1) were recruited. Quality of novice and expert scans did not differ (median score 2.6, interquartile range (IQR) 2.3-2.9 vs. 2.8, IQR 2.3-3.0, respectively p = 0.09). Individual zone quality also did not differ (P > 0.05). Interpretability of LUS was similar between expert and novice scanners (median 7 zones interpretable, IQR 6-8, for both groups, p = 0.42). Interpretability of novice-obtained scans did not differ from expert scans (median 7 out of 8 zones, IQR 6-8, p = 0.42). Novice-users can self-obtain interpretable, expert-quality LUS clips with minimal training. Patient-performed LUS may be feasible for outpatient home monitoring.
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Affiliation(s)
- Nicole M Duggan
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, NH-2, Boston, MA, 02115, USA.
| | - Nick Jowkar
- Department of Radiology, Brigham and Women's Hospital, Boston, USA
| | - Irene W Y Ma
- Division of General Internal Medicine, University of Calgary, Calgary, Canada
| | - Sara Schulwolf
- University of Connecticut School of Medicine, Farmington, USA
| | - Lauren A Selame
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, NH-2, Boston, MA, 02115, USA
| | - Chanel E Fischetti
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, NH-2, Boston, MA, 02115, USA
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Boston, USA
| | - Andrew J Goldsmith
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, NH-2, Boston, MA, 02115, USA
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Wells E, Taylor JL, Wilkes M, Prosser-Snelling E. Successful implementation of round-the-clock care in a virtual ward during the COVID-19 pandemic. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:1040-1044. [PMID: 36370399 DOI: 10.12968/bjon.2022.31.20.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic led to unprecedented demand on NHS infrastructure. Virtual wards (VW) were created in response, using technology to monitor patients remotely. Their implementation required new systems of staffing, escalation, risk management and information governance. The Norfolk and Norwich University Hospitals Foundation Trust offered an example of a highly successful VW. It cared for 852 patients in its first year of operation, providing 24/7 nursing cover, supported by pharmacists and junior doctors, daily consultant-led ward rounds and virtual visits. The remote care platform collected continuous vital sign observations and generated custom alarms. The care team triaged, then escalated to nurse-specialists or consultants as required. Patients reported increased confidence and relief at earlier discharge. Staff highlighted the benefits of working from home, even if isolating or shielding. Challenges included developing awareness of the new service, overcoming concerns around increased workload and transitioning from emergency to long-term funding. The ward subsequently expanded from COVID-19 to nine other use cases.
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Affiliation(s)
- Emily Wells
- Chief Nursing Information Officer, Norfolk and Norwich University Hospitals NHS Foundation Trust
| | | | - Matt Wilkes
- Associate Director of Clinical Affairs, Current Health Ltd, Edinburgh
| | - Ed Prosser-Snelling
- Consultant in Obstetrics and Gynaecology, Chief Clinical Information Officer, Norfolk and Norwich University Hospitals NHS Foundation Trust
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30
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Peiris S, Nates JL, Toledo J, Ho YL, Sosa O, Stanford V, Aldighieri S, Reveiz L. Hospital readmissions and emergency department re-presentation of COVID-19 patients: a systematic review. Rev Panam Salud Publica 2022; 46:e142. [PMID: 36245904 PMCID: PMC9553017 DOI: 10.26633/rpsp.2022.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Objective.
To characterize the frequency, causes, and predictors of readmissions of COVID-19 patients after discharge from heath facilities or emergency departments, interventions used to reduce readmissions, and outcomes of COVID-19 patients discharged from such settings.
Methods.
We performed a systematic review for case series and observational studies published between January 2020 and April 2021 in PubMed, Embase, LILACS, and MedRxiv, reporting the frequency, causes, or risk factors for readmission of COVID-19 survivors/patients. We conducted a narrative synthesis and assessed the methodological quality using the JBI critical appraisal checklist.
Results.
We identified 44 studies including data from 10 countries. The overall 30-day median readmission rate was 7.1%. Readmissions varied with the length of follow-up, occurring <10.5%, <14.5%, <21.5%, and <30%, respectively, for 10, 30, 60, and 253 days following discharge. Among those followed up for 30 and 60 days, the median time from discharge to readmission was 3 days and 8–11 days, respectively. The significant risk factor associated with readmission was having shorter length of stay, and the important causes included respiratory or thromboembolic events and chronic illnesses. Emergency department re-presentation was >20% in four studies. Risk factors associated with mortality were male gender, advanced age, and comorbidities.
Conclusions.
Readmission of COVID-19 survivors is frequent, and post-discharge mortality is significant in specific populations. There is an urgent need to further examine underlying reasons for early readmission and to prevent additional readmissions and adverse outcomes in COVID-19 survivors.
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Affiliation(s)
- Sasha Peiris
- Pan American Health Organization, Washington, D.C., United States of America
| | | | - Joao Toledo
- Pan American Health Organization, Washington, D.C., United States of America
| | - Yeh-Li Ho
- Universidade de São Paulo, São Paulo, Brazil
| | - Ojino Sosa
- Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Victoria Stanford
- Pan American Health Organization, Washington, D.C., United States of America
| | - Sylvain Aldighieri
- Pan American Health Organization, Washington, D.C., United States of America
| | - Ludovic Reveiz
- Pan American Health Organization, Washington, D.C., United States of America
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Jaromy M, Miller JD. Potential Clinical Applications for Continuous Ketone Monitoring in the Hospitalized Patient with Diabetes. Curr Diab Rep 2022; 22:501-510. [PMID: 35984565 PMCID: PMC9388986 DOI: 10.1007/s11892-022-01489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW In this review, the authors discuss potential clinical applications for continuous ketone monitoring (CKM) in a broad continuum of clinical settings from pre-hospital care and the emergency department to acute inpatient management and post-discharge follow-up. RECENT FINDINGS Though in its early stages, the concept of a novel continuous ketone sensing technology exerts great potential for use in the detection and hospital management of DKA, namely to overcome diagnostic barriers associated with ketoacidosis in patients with diabetes and obtain real-time BOHB levels, which may be useful in understanding both patients' response to treatment and DKA trajectory. Peri- and intra-operative use of CKM technology can potentially be applied in a number of urgent and elective surgical procedures frequently underwent by patients with diabetes and in the observation of patients during peri-operative fasting. In transitional care management, CKM technology could potentially facilitate patients' safe transition through levels of care, following hospital discharge from a DKA episode. This evaluation of the literature presents the potential advantages of adopting CKM and integrating this technology into the care algorithm of patients at risk for ketoacidosis.
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Affiliation(s)
- Michelle Jaromy
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, Oyster Bay, NY 11545 USA
| | - Joshua D. Miller
- Division of Endocrinology and Metabolism, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd, Stony Brook, Brookhaven, NY 11794 USA
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Ganton J, Hubbard A, Kovacs Burns K. Patients with COVID-19 share their experiences of recovering at home following hospital care transitions and discharge preparation. Health Expect 2022; 25:2862-2875. [PMID: 36134451 PMCID: PMC9538741 DOI: 10.1111/hex.13595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patients discharged following hospitalization for COVID-19 require clear discharge protocols, information resources and communications to adequately prepare them to safely and successfully transition from hospital to home. Our study focuses on the patients' transition to recovering at home including their hospital discharge preparation and hospital experiences. METHODS A qualitative descriptive study design involved interviewing patients who had been hospitalized for COVID-19 in one urban Alberta, Canada centre. Purposive sampling was used to select patients from a centralized COVID-19 hospital patient database stratified by month between March 2020 and February 2021. Other inclusion criteria (e.g., sex and age) were also considered. Semi-structured interviews with patients were recorded, transcribed and analysed using thematic analysis. Data sufficiency and saturation were determined. RESULTS Twelve patients shared their lived experiences and recovery journey from COVID-19. Themes were reported under three main areas as framed by the study aim-the current status of patients recovering at home, including the supports they used to manage; their discharge process and preparation to go home; and their various hospital-related experiences. Suggestions for improving aspects of the patient journey were also captured. CONCLUSION Findings provided details of the needs, information gaps and what matters most to patients when they are recovering from COVID-19 at home, including their preparation to safely and successfully transition from hospital to home (i.e., feeling well prepared to go home, including being adequately assessed and having clear discharge protocols and communication). Key learnings were applied to improve or develop patient discharge and transition resources. PATIENT OR PUBLIC CONTRIBUTION A patient/family advisor and patient experience partners were involved throughout the study, codeveloping all aspects, from the study design to the reporting and application of the findings. Leading into the study, patient experiences and feedback regarding the home from hospital recovery journey informed multiple aspects, including the codevelopment of the interview guide.
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Affiliation(s)
- Joanne Ganton
- Alberta Health Services Primary Health Care, Edmonton, Alberta, Canada
| | - Amberley Hubbard
- Alberta Health Services Primary Health Care, Edmonton, Alberta, Canada
| | - Katharina Kovacs Burns
- Alberta Health Services Primary Health Care, Edmonton, Alberta, Canada.,Cinical Quality Metrics Data & Analytics, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Bae YS, Sung S, Lee J, Lee H, Chie EK. Building and implementing a contactless clinical trial protocol for patients with COVID-19: A Korean perspective. Front Med (Lausanne) 2022; 9:975243. [PMID: 36186782 PMCID: PMC9520334 DOI: 10.3389/fmed.2022.975243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction To effectively manage patients with coronavirus disease 2019 (COVID-19) while minimizing contact between medical staff, clinical trial protocol that facilitates contactless patient management was designed to predict deterioration of disease condition and monitor mental health status. Methods Through consultation with infectious disease specialists and psychiatrists, this study identified main clinical indicators related to respiratory and non-respiratory outcomes, and mental health. Telehealth devices that could collect relevant data indicators were explored. The following three modes were identified: wearable devices, video calls, and online questionnaires. Clinical trial protocol was implemented to patients confirmed with COVID-19 infection and admitted to Seongnam residential treatment centers between September 1, 2021 and December 30, 2021. Data were collected from wearable devices, video calls, online questionnaires, and from electronic health records. Participant satisfaction was assessed through an online survey at the time of discharge. Results In total, 120 asymptomatic and mildly symptomatic COVID-19 patients participated in this trial. Seven types of physiological and life log data were collected from 87 patients using wearable devices, video and audio recordings, and online mental health-related questionnaire. Most participants were satisfied with the overall trial process, but perceived difficulties in using telehealth devices. Conclusion This trial collected simultaneously generated multimodal patient data using various telehealth devices in a contactless setting for COVID-19 patients. Data collected in this study will be used to build a remote patient management system based on the prediction algorithms.
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Affiliation(s)
- Ye Seul Bae
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sumi Sung
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Jungeun Lee
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Hyeonji Lee
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Eui Kyu Chie
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
- Department of Radiation Oncology, College of Medicine, Seoul National University, Seoul, South Korea
- Medical Research Center, Institute of Radiation Medicine, Seoul National University, Seoul, South Korea
- *Correspondence: Eui Kyu Chie
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Beaney T, Clarke J, Alboksmaty A, Flott K, Fowler A, Benger J, Aylin PP, Elkin S, Neves AL, Darzi A. Population-level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design. Emerg Med J 2022; 39:575-582. [PMID: 35418406 PMCID: PMC9023854 DOI: 10.1136/emermed-2022-212378] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/30/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND To identify the population-level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home (CO@h)) in England on mortality and health service use. METHODS We conducted a retrospective cohort study using a stepped wedge pre-implementation and post-implementation design, including all 106 Clinical Commissioning Groups (CCGs) in England implementing a local CO@h programme. All symptomatic people with a positive COVID-19 PCR test result from 1 October 2020 to 3 May 2021, and who were aged ≥65 years or identified as clinically extremely vulnerable were included. Care home residents were excluded. A pre-intervention period before implementation of the CO@h programme in each CCG was compared with a post-intervention period after implementation. Five outcome measures within 28 days of a positive COVID-19 test: (i) death from any cause; (ii) any ED attendance; (iii) any emergency hospital admission; (iv) critical care admission and (v) total length of hospital stay. RESULTS 217 650 people were eligible and included in the analysis. Total enrolment onto the programme was low, with enrolment data received for only 5527 (2.5%) of the eligible population. The period of implementation of the programme was not associated with mortality or length of hospital stay. The period of implementation was associated with increased health service utilisation with a 12% increase in the odds of ED attendance (95% CI: 6% to 18%) and emergency hospital admission (95% CI: 5% to 20%) and a 24% increase in the odds of critical care admission in those admitted (95% CI: 5% to 47%). In a secondary analysis of CO@h sites with at least 10% or 20% of eligible people enrolled, there was no significant association with any outcome measure. CONCLUSION At a population level, there was no association with mortality before and after the implementation period of the CO@h programme, and small increases in health service utilisation were observed. However, lower than expected enrolment is likely to have diluted the effects of the programme at a population level.
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Affiliation(s)
- Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Jonathan Clarke
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | - Ahmed Alboksmaty
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Kelsey Flott
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Paul P Aylin
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sarah Elkin
- Imperial College Healthcare NHS Trust, London, UK
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
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Andritoi D, Luca C, Onu I, Corciova C, Fuior R, Salceanu A, Iordan DA. The Use of Modern Technologies in Post-COVID-19 Cardiopulmonary Rehabilitation. APPLIED SCIENCES 2022; 12:7471. [DOI: 10.3390/app12157471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Managing cardiopulmonary rehabilitation in patients with COVID-19 remains a global challenge due to the facets of this virus. The technologies used in the rehabilitation of post-COVID-19 patients fail to keep pace with the global epidemiological developments. The purpose of this article is to review the medical technologies used in post-COVID-19 cardiopulmonary rehabilitation and the innovations that have allowed us to adapt and care for our patients. The pandemic highlighted the need for seismic changes in diagnostic and rehabilitation paradigms. We discuss advances in telemedicine and telemedicine-based rehabilitation, remote patient monitoring and emerging technologies used in cardiopulmonary rehabilitation. The rapid adoption of modern technologies in the practice of post-COVID-19 cardiopulmonary rehabilitation is promising and can improve patients’ access to complex rehabilitation programs with outstanding results.
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Jain S, Agarwal A, Bhardwaj A, Lakshmi PVM, Singh M, Chauhan A, Singh M. Remote Monitoring and Holistic Care of Home-Isolated COVID-19 Positive Healthcare Workers Through Digital Technology During the Omicron (B1.1.529) Wave: A Prospective Cohort Study From India. Front Public Health 2022; 10:936000. [PMID: 35910868 PMCID: PMC9326076 DOI: 10.3389/fpubh.2022.936000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
BackgroundRemote monitoring through digital technology offers a promising solution for the diverse medical, psychological and social issues that plague patients with COVID-19 under home-isolation, but remain neglected due to a lack of streamlined medical services for these patients.MethodsThis prospective cohort study determined the feasibility of remote telemonitoring of healthcare workers with mild COVID-19 under home isolation during the Omicron (B1.1.529) wave and characterized their clinico-demographic profile. A holistic monitoring model comprising of mandatory phone calls at the beginning and end of isolation, assisted by home oximetry, predesigned google forms, and opt-in software-based (eSanjeevani OPD) teleconsultation was employed. Factors associated with development of symptomatic disease were also determined.ResultsOut of 100 COVID-19 positive healthcare workers under home-isolation, data for 94 participants was available [median age 27(20–52) years, 56(60%) females]. 93(99%) patients were previously vaccinated for COVID-19 (median time from last dose = 248 days); 34(36%) had a past history of COVID-19. Fever (67%), myalgia (69%), sore throat/dry cough (70%), and running nose (45%) were the most common symptoms. No patient progressed to moderate-severe disease or required care escalation during the remote monitoring period. Most participants reported several additional psychosocial concerns which were adequately addressed. Symptomatic patients had higher BMI (24.1 vs. 21.8kg/m2, p = 0.01) compared to asymptomatic patients. Age, past infection with COVID-19, and time since last vaccine dose were not different between symptomatic and asymptomatic patients.ConclusionCOVID-19 patients under home isolation have multi-faceted medical and psychosocial issues which can be holistically managed remotely through digital technology.
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Affiliation(s)
- Siddharth Jain
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Agarwal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupriya Bhardwaj
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - PVM Lakshmi
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvi Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Chauhan
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Meenu Singh
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Kuo S, Aledia A, O’Connell R, Rudkin S, Dangodara AA, Amin AN. Implementation and impact on length of stay of a post-discharge remote patient monitoring program for acutely hospitalized COVID-19 pneumonia patients. JAMIA Open 2022; 5:ooac060. [PMID: 35879961 PMCID: PMC9278264 DOI: 10.1093/jamiaopen/ooac060] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/12/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022] Open
Abstract
Objective In order to manage COVID-19 patient population and bed capacity issues, remote patient monitoring (RPM) is a strategy used to transition patients from inpatients to home. We describe our RPM implementation process for post-acute care COVID-19 pneumonia patients. We also evaluate the impact of RPM on patient outcomes, including hospital length of stay (LOS), post-discharge Emergency Department (ED) visits, and hospital readmission. Materials and Methods We utilized a cloud-based RPM platform (Vivify Health) and a nurse-monitoring service (Global Medical Response) to enroll COVID-19 patients who required oxygen supplementation after hospital discharge. We evaluated patient participation, biometric alerts, and provider communication. We also assessed the program’s impact by comparing RPM patient outcomes with a retrospective cohort of Control patients who similarly required oxygen supplementation after discharge but were not referred to the RPM program. Statistical analyses were performed to evaluate the 2 groups’ demographic characteristics, hospital LOS, and readmission rates. Results The RPM program enrolled 75 patients with respondents of a post-participation survey reporting high satisfaction with the program. Compared to the Control group (n = 150), which had similar demographics and baseline characteristics, the RPM group was associated with shorter hospital LOS (median 4.8 vs 6.1 days; P=.03) without adversely impacting return to the ED or readmission. Conclusion We implemented a RPM program for post-acute discharged COVID-19 patients requiring oxygen supplementation. Our RPM program resulted in a shorter hospital LOS without adversely impacting quality outcomes for readmission rates and improved healthcare utilization by reducing the average LOS.
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Affiliation(s)
- Sherwin Kuo
- Department of Medicine/Hospital Medicine, UC Irvine Health , Orange, California, USA
- Clinical Informatics Program, UC Irvine Health , Orange, California, USA
| | - Anna Aledia
- Department of Medicine/Hospital Medicine, UC Irvine Health , Orange, California, USA
| | - Ryan O’Connell
- Clinical Informatics Program, UC Irvine Health , Orange, California, USA
- Department of Pathology, UC Irvine Health , Orange, California, USA
| | - Scott Rudkin
- Clinical Informatics Program, UC Irvine Health , Orange, California, USA
- Department of Emergency Medicine, UC Irvine Health , Orange, California, USA
| | - Amish A Dangodara
- Department of Medicine/Hospital Medicine, UC Irvine Health , Orange, California, USA
- Clinical Informatics Program, UC Irvine Health , Orange, California, USA
| | - Alpesh N Amin
- Department of Medicine/Hospital Medicine, UC Irvine Health , Orange, California, USA
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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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Joshi E, Mann JM, Goodwin ME, Collins AL, Atkins NE, Khor YH, McDonald CF. Perceptions of Individuals With Chronic Lung Disease on Home Use of Pulse Oximetry. Respir Care 2022; 67:801-806. [PMID: 35504723 PMCID: PMC9994095 DOI: 10.4187/respcare.09708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulse oximeters are often used at home by patients with chronic respiratory diseases and more recently for remote monitoring of patients with COVID-19. There are no published data outside a supervised telemedicine setting regarding patients' experiences with these devices. Our objective was to explore patients' usage patterns and perceptions of using pulse oximetry at home. METHODS Patients with chronic respiratory disease who had a pulse oximeter at home were recruited to complete a structured survey. RESULTS Thirty participants with a range of chronic respiratory diseases (mean age 71 y, 16 females) were recruited. Most participants (83%) used home oxygen therapy. Pulse oximeters were bought online (46.7%), at a pharmacy (40%), at a medical equipment store (6.7%), through a clinic (3.3%), or from an oxygen supplier (3.3%). Use was self-initiated in 56.7% of cases and was based on a health care-related recommendation in 26.7% of cases. Sixty percent of participants used the oximeter daily, with 90% expressing confidence in interpreting their oximeter readings primarily due to education from health care professionals and in-patient experiences. Almost all participants adjusted their activity levels or management based upon oximeter readings. Most participants reported that using a pulse oximeter at home was helpful in judging their physical limitations and provided reassurance and confidence in their disease management. CONCLUSIONS Subjects appeared confident in their use of home pulse oximetry. Health professionals should identify patients who use pulse oximeters for monitoring and ensure that they are able to interpret readings correctly and, if appropriate, adjust management safely.
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Affiliation(s)
- Esha Joshi
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; and Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Jennifer M Mann
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; and Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Maureen E Goodwin
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Allison L Collins
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; and Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Naomi E Atkins
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; and Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Yet Hong Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; and Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; and Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
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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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Vilendrer S, Lestoquoy A, Artandi M, Barman L, Cannon K, Garvert DW, Halket D, Holdsworth LM, Singer S, Vaughan L, Winget M. A 360 degree mixed-methods evaluation of a specialized COVID-19 outpatient clinic and remote patient monitoring program. BMC PRIMARY CARE 2022; 23:151. [PMID: 35698064 PMCID: PMC9189794 DOI: 10.1186/s12875-022-01734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Our goals are to quantify the impact on acute care utilization of a specialized COVID-19 clinic with an integrated remote patient monitoring program in an academic medical center and further examine these data with stakeholder perceptions of clinic effectiveness and acceptability. METHODS A retrospective cohort was drawn from enrolled and unenrolled ambulatory patients who tested positive in May through September 2020 matched on age, presence of comorbidities and other factors. Qualitative semi-structured interviews with patients, frontline clinician, and administrators were analyzed in an inductive-deductive approach to identify key themes. RESULTS Enrolled patients were more likely to be hospitalized than unenrolled patients (N = 11/137 in enrolled vs 2/126 unenrolled, p = .02), reflecting a higher admittance rate following emergency department (ED) events among the enrolled vs unenrolled, though this was not a significant difference (46% vs 25%, respectively, p = .32). Thirty-eight qualitative interviews conducted June to October 2020 revealed broad stakeholder belief in the clinic's support of appropriate care escalation. Contrary to beliefs the clinic reduced inappropriate care utilization, no difference was seen between enrolled and unenrolled patients who presented to the ED and were not admitted (N = 10/137 in enrolled vs 8/126 unenrolled, p = .76). Administrators and providers described the clinic's integral role in allowing health services to resume in other areas of the health system following an initial lockdown. CONCLUSIONS Acute care utilization and multi-stakeholder interviews suggest heightened outpatient observation through a specialized COVID-19 clinic and remote patient monitoring program may have contributed to an increase in appropriate acute care utilization. The clinic's role securing safe reopening of health services systemwide was endorsed as a primary, if unmeasured, benefit.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA.
| | - Anna Lestoquoy
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Maja Artandi
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Linda Barman
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Kendell Cannon
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Donn W Garvert
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Douglas Halket
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Laura M Holdsworth
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Sara Singer
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Laura Vaughan
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Marcy Winget
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
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Cohen AB, Stump L, Krumholz HM, Cartiera M, Jain S, Scott Sussman L, Hsiao A, Lindop W, Ying AK, Kaul RL, Balcezak TJ, Tereffe W, Comerford M, Jacoby D, Navai N. Aligning mission to digital health strategy in academic medical centers. NPJ Digit Med 2022; 5:67. [PMID: 35654885 PMCID: PMC9163186 DOI: 10.1038/s41746-022-00608-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/29/2022] [Indexed: 01/09/2023] Open
Abstract
The strategies of academic medical centers arise from core values and missions that aim to provide unmatched clinical care, patient experience, research, education, and training. These missions drive nearly all activities. They should also drive digital health activities - and particularly now given the rapid adoption of digital health, marking one of the great transformations of healthcare; increasing pressures on health systems to provide more cost-effective care; the pandemic-accelerated funding and rise of well-funded new entrants and technology giants that provide more convenient forms of care; and a more favorable regulatory and reimbursement landscape to incorporate digital health approaches. As academic medical centers emerge from a pandemic-related reactionary digital health posture, where pressures to adopt more digital health technologies mount, a broad digital health realignment that leverages the strengths of such centers is required to accomplish their missions.
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Affiliation(s)
- Adam B Cohen
- Yale New Haven Health, 20 York Street, New Haven, CT, 06510, USA.
| | - Lisa Stump
- Yale New Haven Health, 20 York Street, New Haven, CT, 06510, USA
| | | | | | - Sanchita Jain
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - L Scott Sussman
- Yale New Haven Health, 20 York Street, New Haven, CT, 06510, USA
| | - Allen Hsiao
- Yale New Haven Health, 20 York Street, New Haven, CT, 06510, USA
| | - Walter Lindop
- Yale New Haven Health, 20 York Street, New Haven, CT, 06510, USA
| | - Anita Kuo Ying
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Rebecca L Kaul
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | | | - Welela Tereffe
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | | | - Daniel Jacoby
- Yale New Haven Health, 20 York Street, New Haven, CT, 06510, USA
| | - Neema Navai
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
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Georghiou T, Sherlaw-Johnson C, Massou E, Morris S, Crellin NE, Herlitz L, Sidhu MS, Tomini SM, Vindrola-Padros C, Walton H, Fulop NJ. The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: A national observational study using hospital activity data. EClinicalMedicine 2022; 48:101441. [PMID: 35582125 PMCID: PMC9098201 DOI: 10.1016/j.eclinm.2022.101441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND There was a national roll out of 'COVID Virtual Wards' (CVW) during England's second COVID-19 wave (Autumn 2020 - Spring 2021). These services used remote pulse oximetry monitoring for COVID-19 patients following discharge from hospital. A key aim was to enable rapid detection of patient deterioration. It was anticipated that the services would support early discharge, reducing pressure on beds. This study is an evaluation of the impact of the CVW services on hospital activity. METHODS Using retrospective patient-level hospital admissions data, we built multivariate models to analyze the relationship between the implementation of CVW services and hospital activity outcomes: length of COVID-19 related stays and subsequent COVID-19 readmissions within 28 days. We used data from more than 98% of recorded COVID-19 hospital stays in England, where the patient was discharged alive between mid-August 2020 and late February 2021. FINDINGS We found a longer length of stay for COVID-19 patients discharged from hospitals where a CVW was available, when compared to patients discharged from hospitals where there was no CVW (adjusted IRR 1·05, 95% CI 1·01 to 1·09). We found no evidence of a relationship between the availability of CVW and subsequent rates of readmission for COVID-19 (adjusted OR 0.97, 95% CI 0.91 to 1·03). INTERPRETATION We found no evidence of early discharges or changes in readmissions associated with the roll out of COVID Virtual Wards across England. Our analysis made pragmatic use of national-scale hospital data, but it is possible that a lack of specific data (for example, on which patients were enrolled and on potentially important confounders) may have meant that true impacts, especially at a local level, were not ultimately discernible. It is important that future research is able to make use of better quality - preferably linked - data, from multiple sites. FUNDING This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research program (RSET Project no. 16/138/17; BRACE Project no. 16/138/31) and NHSE&I. NJF is an NIHR Senior Investigator.
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Affiliation(s)
- Theo Georghiou
- Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, United Kingdom
- Corresponding author.
| | | | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, United Kingdom
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, United Kingdom
| | - Nadia E. Crellin
- Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, United Kingdom
| | - Lauren Herlitz
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Manbinder S Sidhu
- Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, 40 Edgbaston Park Rd, Birmingham B15 2RT, United Kingdom
| | - Sonila M. Tomini
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, United Kingdom
| | - Holly Walton
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, United Kingdom
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Participant and Research Team Perspectives on the Conduct of a Remote Therapeutic COVID-19 Clinical Trial: A Mixed Methods Approach. J Clin Transl Sci 2022; 6:e69. [PMID: 35836793 PMCID: PMC9257771 DOI: 10.1017/cts.2022.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Responding to the need to investigate potential treatments of COVID-19, a research team employed a telehealth platform to determine whether niclosamide, an oral anthelmintic drug that had shown antiviral activity, reduced SARS-CoV-2 shedding and duration of symptoms in patients with mild-to-moderate symptoms of COVID-19. To encourage compliance with patient self-quarantine, this randomized placebo-controlled clinical trial was conducted utilizing a remote telehealth design to complete all study visits, monitor symptoms, and coordinate participant self-collected specimens. Methods: A mixed methods approach employing surveys and interviews of trial participants and interviews of research team members was used to collect their experiences with and perspectives on the acceptability of the remote clinical trial design and delivery. Results: Of the 67 eligible trial participants invited to take part in a study to evaluate the telehealth platform, 46% (n = 31) completed a post-participation survey. While 97% (n = 30) of respondents had not previously participated in a clinical trial, 77% (n = 24) reported they would consider taking part in a future remote research study. The majority of respondents were moderately or very comfortable (93%) with using the technology. Conclusions: The COVID-19 crisis was a call to action to expand understanding of the conduct of remote clinical trials, including the experiences of research participants. Our findings showed that this approach can be both effective for the conduct of research and positive for participants. Further research on the use of telehealth research platforms seems warranted in rural, underserved populations, and remote trials of prevention, screening, and treatment.
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Laur C, Agarwal P, Thai K, Kishimoto V, Kelly S, Liang K, Bhatia RS, Bhattacharyya O, Martin D, Mukerji G. Implementation and Evaluation of COVIDCare@Home, a Family Medicine Led Remote Monitoring Program for COVID-19 Patients: a multi-method cross-sectional study. JMIR Hum Factors 2022; 9:e35091. [PMID: 35499974 PMCID: PMC9239565 DOI: 10.2196/35091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background COVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women’s College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity. Objective The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health. Methods This multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H. Results In total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system. Conclusions Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams.
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Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | - Payal Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA
| | - Kelly Thai
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | - Vanessa Kishimoto
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | | | | | - R Sacha Bhatia
- Population Health and Values Based Health Systems, Ontario Health, Toronto, CA.,Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Temerty Faculty of Medicine, University of Toronto, Toronto, CA.,Peter Munk Cardiac Centre, University Health Network, Toronto, CA
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA
| | - Danielle Martin
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA.,Women's College Hospital, Toronto, CA.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, CA
| | - Geetha Mukerji
- Women's College Hospital, Toronto, CA.,Temerty Faculty of Medicine, University of Toronto, Toronto, CA.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, CA
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Suárez-Gil R, Casariego-Vales E, Blanco-López R, Santos-Guerra F, Pedrosa-Fraga C, Fernández-Rial Á, Íñiguez-Vázquez I, Abad-García MM, Bal-Alvaredo M. Efficacy of Telemedicine and At-Home Telemonitoring following Hospital Discharge in Patients with COVID-19. J Pers Med 2022; 12:609. [PMID: 35455725 PMCID: PMC9029667 DOI: 10.3390/jpm12040609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 12/23/2022] Open
Abstract
Aim: This work aims to evaluate the safety and utility of an at-home telemedicine with telemonitoring program for discharged COVID-19 patients. Methods: This is a retrospective cohort study of all patients discharged home in Galicia between 6 March 2020 and 15 February 2021. We evaluated a structured, proactive monitoring program conducted by the ASLAM (Área Sanitaria de Lugo, A Mariña y Monforte de Lemos) Healthcare Area team compared to patients discharged in the rest of the Autonomous Community of Galicia. Results: During the study period, 10,517 patients were hospitalized for COVID-19 and 8601 (81.8%) were discharged. Of them, 738 (8.6%) were discharged in ASLAM and 7863 (91.4%) were discharged in the rest of Galicia. Of those discharged in ASLAM, 475 (64.4%) patients were monitored. Compared to patients in the rest of Galicia, the group monitored via telemedicine had a significantly shorter first hospital stay (p < 0.0001), a lower readmission rate (p = 0.05), and a shorter second hospital stay (p = 0.04), with no differences in emergency department visits or 90-day all-cause mortality. Conclusion: A structured, proactive telemedicine with telemonitoring program for discharged COVID-19 patients is a safe, useful tool that reduces the mean length of hospital stay and readmissions.
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Affiliation(s)
- Roi Suárez-Gil
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (E.C.-V.); (C.P.-F.); (Á.F.-R.); (I.Í.-V.); (M.B.-A.)
| | - Emilio Casariego-Vales
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (E.C.-V.); (C.P.-F.); (Á.F.-R.); (I.Í.-V.); (M.B.-A.)
| | - Rosa Blanco-López
- Day Hospital Nursing, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.B.-L.); (M.M.A.-G.)
| | - Fernando Santos-Guerra
- Information Systems Project Management Department, Galician Health Service, Regional Ministry of Health, 15703 Santiago de Compostela, Spain;
| | - Cristina Pedrosa-Fraga
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (E.C.-V.); (C.P.-F.); (Á.F.-R.); (I.Í.-V.); (M.B.-A.)
| | - Álvaro Fernández-Rial
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (E.C.-V.); (C.P.-F.); (Á.F.-R.); (I.Í.-V.); (M.B.-A.)
| | - Iria Íñiguez-Vázquez
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (E.C.-V.); (C.P.-F.); (Á.F.-R.); (I.Í.-V.); (M.B.-A.)
| | - María Mar Abad-García
- Day Hospital Nursing, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.B.-L.); (M.M.A.-G.)
| | - Mercedes Bal-Alvaredo
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (E.C.-V.); (C.P.-F.); (Á.F.-R.); (I.Í.-V.); (M.B.-A.)
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Alboksmaty A, Beaney T, Elkin S, Clarke JM, Darzi A, Aylin P, Neves AL. Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review. Lancet Digit Health 2022; 4:e279-e289. [PMID: 35337644 PMCID: PMC8940208 DOI: 10.1016/s2589-7500(21)00276-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/25/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. In this systematic review, we aim to assess the effectiveness and safety of pulse oximetry in remote patient monitoring (RPM) of patients at home with COVID-19. We searched five databases (MEDLINE, Embase, Global Health, medRxiv, and bioRxiv) from database inception to April 15, 2021, and included feasibility studies, clinical trials, and observational studies, including preprints. We found 561 studies, of which 13 were included in our narrative synthesis. These 13 studies were all observational cohorts and involved a total of 2908 participants. A meta-analysis was not feasible owing to the heterogeneity of the outcomes reported in the included studies. Our systematic review substantiates the safety and potential of pulse oximetry for monitoring patients at home with COVID-19, identifying the risk of deterioration and the need for advanced care. The use of pulse oximetry can potentially save hospital resources for patients who might benefit the most from care escalation; however, we could not identify explicit evidence for the effect of RPM with pulse oximetry on health outcomes compared with other monitoring models such as virtual wards, regular monitoring consultations, and online or paper diaries to monitor changes in symptoms and vital signs. Based on our findings, we make 11 recommendations across the three Donabedian model domains and highlight three specific measurements for setting up an RPM system with pulse oximetry.
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Affiliation(s)
- Ahmed Alboksmaty
- NIHR Patient Safety Translational Research Centre, Department of Primary Care and Public Health, Imperial College London, London, UK.
| | - Thomas Beaney
- NIHR Patient Safety Translational Research Centre, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sarah Elkin
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College and Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan M Clarke
- Institute of Global Health Innovation, Imperial College London, London, UK; EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Aylin
- NIHR Patient Safety Translational Research Centre, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ana-Luísa Neves
- NIHR Patient Safety Translational Research Centre, Department of Primary Care and Public Health, Imperial College London, London, UK
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Abstract
The COVID-19 pandemic put an unprecedented strain on clinical research worldwide. As in-person clinical trials came to a screeching halt, we sought new ways to move forward, or as Bob Dylan put it, "start swimmin' or sink like a stone." Telemedicine has long been a part of medicine and clinical research, but fully remote clinical trials were few and far between. In the midst of the pandemic, at the Washington University School of Medicine we successfully conducted a fully remote clinical trial for a potential COVID-19 therapy, demonstrating the feasibility of fully remote or decentralized clinical trials.
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49
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Molinaro N, Schena E, Silvestri S, Bonotti F, Aguzzi D, Viola E, Buccolini F, Massaroni C. Contactless Vital Signs Monitoring From Videos Recorded With Digital Cameras: An Overview. Front Physiol 2022; 13:801709. [PMID: 35250612 PMCID: PMC8895203 DOI: 10.3389/fphys.2022.801709] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 01/26/2023] Open
Abstract
The measurement of physiological parameters is fundamental to assess the health status of an individual. The contactless monitoring of vital signs may provide benefits in various fields of application, from healthcare and clinical setting to occupational and sports scenarios. Recent research has been focused on the potentiality of camera-based systems working in the visible range (380-750 nm) for estimating vital signs by capturing subtle color changes or motions caused by physiological activities but invisible to human eyes. These quantities are typically extracted from videos framing some exposed body areas (e.g., face, torso, and hands) with adequate post-processing algorithms. In this review, we provided an overview of the physiological and technical aspects behind the estimation of vital signs like respiratory rate, heart rate, blood oxygen saturation, and blood pressure from digital images as well as the potential fields of application of these technologies. Per each vital sign, we provided the rationale for the measurement, a classification of the different techniques implemented for post-processing the original videos, and the main results obtained during various applications or in validation studies. The available evidence supports the premise of digital cameras as an unobtrusive and easy-to-use technology for physiological signs monitoring. Further research is needed to promote the advancements of the technology, allowing its application in a wide range of population and everyday life, fostering a biometrical holistic of the human body (BHOHB) approach.
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Affiliation(s)
- Nunzia Molinaro
- Unit of Measurements and Biomedical Instrumentation, Departmental Faculty of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Departmental Faculty of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sergio Silvestri
- Unit of Measurements and Biomedical Instrumentation, Departmental Faculty of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Damiano Aguzzi
- BHOHB – Biometrical Holistic of Human Body S.r.l., Rome, Italy
| | - Erika Viola
- BHOHB – Biometrical Holistic of Human Body S.r.l., Rome, Italy
| | - Fabio Buccolini
- BHOHB – Biometrical Holistic of Human Body S.r.l., Rome, Italy
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Departmental Faculty of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
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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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