Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study (Preprint)

Abstract

BACKGROUND The COVID-19 pandemic has imposed immense stress on global healthcare systems, especially in Low and Middle-Income Countries (LMIC). Armenia, a middle income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained healthcare infrastructure. OBJECTIVE The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. METHODS Seven hospitals in Yerevan participated in the COVID@home program. A web application based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from 1) eligibility and enrollment forms, 2) daily monitoring forms, and 3) discharge forms. RESULTS Over 11 months, 439 patients were screened, and 221 were managed and discharged. 94% of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 days. Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1% and low readmission rate. Opportunities for operational and data quality improvements were identified. CONCLUSIONS This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing COVID-19 patients in resource-constrained settings. The COVID@home program's success provides a model for remote patient care, potentially alleviating strain on healthcare resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable healthcare solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments.