Abstract:Background:
Virtual care for patients with coronavirus disease 2019 (COVID-19) allows providers to monitor COVID-19-positive patients with variable trajectories while reducing the risk of transmission to others and ensuring health care capacity in acute care facilities. The objective of this descriptive analysis was to assess the initial adoption, feasibility and safety of a family medicine–led remote monitoring program, COVIDCare@Home, to manage the care of patients with COVID-19 in the community… Show more
“… 11 , 12 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 The RPM models in eight studies did not include pulse oximetry as a monitoring tool for all participants but only for specific subgroups, and these studies were excluded. 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 One study was excluded owing to reporting irrelevant outcomes, focusing on therapeutic options with less emphasis on the RPM model. 43 Figure 2 PRISMA diagram showing the study selection process …”
“… 11 , 12 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 The RPM models in eight studies did not include pulse oximetry as a monitoring tool for all participants but only for specific subgroups, and these studies were excluded. 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 One study was excluded owing to reporting irrelevant outcomes, focusing on therapeutic options with less emphasis on the RPM model. 43 Figure 2 PRISMA diagram showing the study selection process …”
“…Adaptive leadership and ongoing improvement cycles were used to adapt the program to meet system needs as the pandemic evolved [ 29 ]. An in-depth description of the strategies used to adapt the program and additional contextual factors are provided elsewhere [ 29 ], as are details about the model of care [ 27 ]. A patient-facing outline of the program is provided in Figure 1 .…”
Section: Methodsmentioning
confidence: 99%
“…The aim of this study was to conduct a comprehensive evaluation of the first 8 months of COVIDCare@Home (CC@H), a remote monitoring program, based at Women’s College Hospital (WCH) in Toronto, Canada, that aims to address the clinical and socioeconomic needs of patients during the acute phase of COVID-19. A detailed description of the program is provided separately [ 27 ]. Lessons from this program may be more broadly applicable to the use of remote monitoring for other acute and chronic conditions and are thus highly amenable to a primary care/family medicine approach [ 2 ].…”
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.
BackgroundRemote home monitoring of people testing positive for COVID-19 using pulse oximetry was implemented across England during the Winter of 2020/21 to identify falling blood oxygen saturation levels at an early stage. This was hypothesised to enable earlier hospital admission, reduce the need for intensive care and improve survival. This study is an evaluation of the clinical effectiveness of the pre-hospital monitoring programme, COVID oximetry @home (CO@h).MethodsWe analysed relationships at a geographical area level between the extent to which people aged 65 or over were enrolled onto the programme and outcomes over the period between November 2020 to February 2021FindingsFor every 10% increase in coverage of the programme, mortality was reduced by 2% (95% confidence interval: -4% to 1%), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1·8% (-1·2% to 4·9%). None of these results are statistically significant.InterpretationThere are several possible explanations for our findings. One is that the CO@h did not have the hypothesised impact. Another is that the low rates of enrolment and incomplete data in many areas reduced the chances of detecting any impact that may have existed. Also, CO@h has been implemented in many different ways across the country and these may have had varying levels of effect.FundingThis is independent research funded by the National Institute for Health Research, Health Services & Delivery Research programme (RSET Project no. 16/138/17; BRACE Project no. 16/138/31) and NHSEI. NJF is an NIHR Senior Investigator. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.Research in ContextEvidence before this studyExisting evidence before this study and the search strategy used to obtain this evidence has been published previously by the authors in a systematic review. Previous quantitative studies have assessed remote oximetry monitoring services for COVID-19 patients mostly at individual sites and focussed on their safety. However, their effectiveness has been little studied. This may reflect the challenges of identifying reliable counterfactuals during a rapidly evolving pandemic.Added value of this studyThis study is part of a wider mixed methods evaluation that followed the rapid implementation of remote monitoring across the English NHS during the Winter of 2020/21. It adds to the evidence of the effectiveness of such programmes at a national level.Implications of the available evidenceThere is some existing evidence that remote monitoring of COVID-19 patients can be locally effective although we have not been able to replicate such findings at a wider level. Missing data and lower coverage of the service than expected may have influenced our results, and the effectiveness of some local programmes could have been lost among the analysis of national data. Future implementation requires better data collection strategies which could be focussed within fewer local areas, and effective learning from areas that have achieved better population coverage.
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