Home-based COVID 19 management: A consensus document from Italian general medical practitioners and hospital consultants in the Lombardy region (Italy)

Morici, Nuccia; Puoti, Massimo; Zocchi, Maria Teresa; Brambilla, C.; Mangiagalli, Andrea; Savonitto, Stefano

doi:10.1016/j.ejim.2020.11.025

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Mild-to-moderate COVID-19 outpatient clinic physicians are internal medicine doctors. Criteria for referral to MMCOs of patients with moderate COVID-19 by GPs are derived from official regional regulations ( 5 , 6 ). Prior to patient evaluation at the MMCO, the GP provides the MMCO physician with a comprehensive report, in the form of a standardized questionnaire ( Supplementary Figure 1 ), on the patient’s past medical history, COVID-19-related symptoms, time from symptom onset, peripheral oxygen saturation (SpO 2 ), body mass index (BMI), chronic therapies and COVID-19-specific treatments.…”

Section: Methodsmentioning

confidence: 99%

“…While patients with mild disease and no risk factors for progression may benefit from medical assistance by general practitioners (GPs), those with moderate COVID-19 or harboring risk factors for adverse outcomes reside in a gray area between in-hospital and home management ( 5 ). Within the latter patient category, GPs may not have the tools to discriminate nor handle patients deserving more attentive monitoring.…”

Section: Introductionmentioning

confidence: 99%

“…On the heels of the first pandemic wave and with the belief that some measure had to be taken to avoid system collapse, health policymakers of Lombardy region in Italy at the beginning of the second wave designed an integrated approach of healthcare delivery, called “Hot Spot” or “Mild-to-moderate COVID-19 outpatient clinic” (MMCO), based on the strict, bidirectional collaboration with GPs and the ED ( 5 ). One year after the introduction of this novel service, here we describe our preliminary experience of patient management at two MMCOs of the metropolitan city of Milan, specifically those of San Raffaele University Hospital and Luigi Sacco University Hospital.…”

Section: Introductionmentioning

confidence: 99%

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A Pilot Study of the Efficacy and Economical Sustainability of Acute Coronavirus Disease 2019 Patient Management in an Outpatient Setting

Lorenzo

Montagna

Bossi³

et al. 2022

Front. Med.

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ObjectiveTo report a preliminary experience of outpatient management of patients with Coronavirus disease 2019 (COVID-19) through an innovative approach of healthcare delivery.Patients and MethodsPatients evaluated at the Mild-to-Moderate COVID-19 Outpatient clinics (MMCOs) of San Raffaele University Hospital and Luigi Sacco University Hospital in Milan, Italy, from 1 October 2020 to 31 October 2021 were included. Patients were referred by general practitioners (GPs), Emergency Department (ED) physicians or hospital specialists (HS) in case of moderate COVID-19. A classification and regression tree (CART) model predicting ED referral by MMCO physicians was developed to aid GPs identify those deserving immediate ED admission. Cost-effectiveness analysis was also performed.ResultsA total of 660 patients were included. The majority (70%) was referred by GPs, 21% by the ED and 9% by HS. Patients referred by GPs had more severe disease as assessed by peripheral oxygen saturation (SpO2), ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), C-reactive protein (CRP) levels and interstitial involvement at lung ultrasound. Among them, 18% were addressed to the ED following MMCO assessment. CART analysis identified three independent predictors, namely home-measured SpO2, age and body mass index (BMI), that robustly divide patients into risk groups of COVID-19 severity. Home-measured SpO2 < 95% and BMI ≥ 33 Kg/m2 defined the high-risk group. The model yielded an accuracy (95% CI) of 83 (77–88)%. Outpatient management of COVID-19 patients allowed the national healthcare system to spare 1,490,422.05 € when compared with inpatient care.ConclusionMild-to-moderate COVID-19 outpatient clinics were effective and sustainable in managing COVID-19 patients and allowed to alleviate pressure on EDs and hospital wards, favoring effort redirection toward non-COVID-19 patients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Pilot Study of the Efficacy and Economical Sustainability of Acute Coronavirus Disease 2019 Patient Management in an Outpatient Setting

Lorenzo

Montagna

Bossi³

et al. 2022

Front. Med.

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“…This methodology might be informative in order to detect patients with COVID-19 and, among them, those with higher risk of requiring early hospital admission. Our working group has previously released a consensus document drawn up by hospital consultant physicians and GPs in order to stratify patients with symptoms suspected of SARS-CoV-2 infection and improve their management in appropriate “hot spot” facilities [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Algorithm for Individual Prediction of COVID-19–Related Hospitalization Based on Symptoms: Development and Implementation Study

Murtas¹,

Morici²,

Cogliati³

et al. 2021

JMIR Public Health Surveill

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Background The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes. Objective This study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization. Methods A predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed. Results The predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept –0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients. Conclusions A simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic.

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“…Even if this approach is not easily applicable in all European realities, it will involve the larger metropolitan areas. Furthermore, two widely implementable principles should be highlighted: strengthen the bond between primary care and hospital consultants throughout an integrated approach starting from general practitioners' leading activities (which should be applied to SARS-CoV-2 infection as well as most chronic disorders) 12,13 and prioritize cardiovascular networks starting from third-level centres highly specialized in the treatment of advanced HF, as well as respiratory insufficiency. In conclusion, an effort to organize with a rationalization based on high-level competences has to be warranted.…”

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confidence: 99%

The other side of the coin: ‘centralization’ against ‘optimization’ in COVID‐19 pandemic

Morici¹,

Sacco²,

Forleo

et al. 2021

ESC Heart Failure

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Home-based COVID 19 management: A consensus document from Italian general medical practitioners and hospital consultants in the Lombardy region (Italy)

Cited by 7 publications

References 9 publications

A Pilot Study of the Efficacy and Economical Sustainability of Acute Coronavirus Disease 2019 Patient Management in an Outpatient Setting

A Pilot Study of the Efficacy and Economical Sustainability of Acute Coronavirus Disease 2019 Patient Management in an Outpatient Setting

Algorithm for Individual Prediction of COVID-19–Related Hospitalization Based on Symptoms: Development and Implementation Study

The other side of the coin: ‘centralization’ against ‘optimization’ in COVID‐19 pandemic

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