Patient experience and healthcare utilization for a COVID-19 telemedicine home monitoring program offered in English and Spanish

Abstract

Background Telemedicine is a vital component of the healthcare system’s response to COVID-19. In March of 2020, Providence health system rapidly implemented a telemedicine home monitoring program (HMP) for COVID-19 patients that included use of at-home pulse oximeters and thermometers and text-based surveys to monitor symptoms. By June 2020, Providence updated the HMP to be offered in Spanish. This program was implemented before COVID-19 testing was readily available and therefore was offered to all patients suspected of having COVID-19. This study examines engagement, experience, and utilization patterns for English and Spanish-speaking patients engaged in the COVID-19 HMP. Methods A retrospective review of program data was used to understand HMP patient engagement (responsiveness to three daily text to monitor symptoms), satisfaction with the program (likelihood to recommend the program) as well as comfort using home monitoring devices and comfort recovering from home. To understand impact on care for COVID-19 confirmed cases, we used electronic health records to measure patterns in healthcare use for COVID-19 positive HMP participants and non-HMP propensity weighted controls. All patients enrolled in the COVID-19 HMP from March–October 2020 were included in the study. Patients tested for COVID-19 during the time window and not enrolled in HMP were included in the propensity-weighted comparison group. Descriptive and regression analyses were performed overall and stratified by English and Spanish speakers. Results Of the 4,358 HMP participants, 75.5% identified as English speakers and 18.2% identified as Spanish speakers. There was high level of responsiveness to three daily text-based surveys monitoring symptoms engagement (>80%) and a high level of comfort using the home monitoring devices (thermometers and pulse oximeters) for English- and Spanish-speaking participants (97.3% and 99.6%, respectively). The majority of English (95.7%) and Spanish-speaking (100%) patients felt safe monitoring their condition from home and had high satisfaction with the HMP (76.5% and 83.6%, respectively). English and Spanish-speaking COVID-19 positive HMP participants had more outpatient and emergency departments (ED) encounters than non-participants 7 and 30 days after their positive test. Conclusion This widely implemented HMP provided participants with a sense of safety and satisfaction and its use was associated with more outpatient care and ED encounters. These outcomes were comparable across English and Spanish-speakers, highlighting the importance and potential impact of language-concordant telemedicine.

Evaluation of an outreach programme for patients with COVID-19 in an integrated healthcare delivery system: a retrospective cohort study

“…This study did not report hospitalisation rates or rates of clinical outcomes, such as death. 36 There are several limitations to the current analysis. We did not measure physician or patient satisfaction/ experience related to the programme.…”

“…Our programme was implemented on a larger scale but found similar reduction in inpatient mortality. Third, the Home Monitoring Programme at Providence Health System delivered pulse oximeters and thermometers to the home and administered surveys in English/Spanish to monitor symptoms over time 36. The authors performed propensity scores with inverse probability of treatment weighting.…”

“…Of 4358 participants, the programme was associated with more outpatient and emergency department encounters and resulted in high enrollee satisfaction. This study did not report hospitalisation rates or rates of clinical outcomes, such as death 36…”

“…Third, the Home Monitoring Programme at Providence Health System delivered pulse oximeters and thermometers to the home and administered surveys in English/Spanish to monitor symptoms over time. 36 The authors performed propensity scores with inverse probability of treatment weighting. Of 4358 participants, the programme was associated with more outpatient and emergency department encounters and resulted in high enrollee satisfaction.…”

Home oxygen monitoring and therapy: learning from the pandemic

“…Despite variable and scarce evidence of the clinical and cost effectiveness of home oximetry programmes, a largely consistent finding across studies is the positive reception of such programmes by patients. In a study of 4400 patients enrolled in a COVID-19 home monitoring programme in the USA, around 78% of participants were satisfied with the programme and 97% of respondents felt safe monitoring their condition at home [46]. In a cohort of 257 oncology patients diagnosed with COVID-19 who were enrolled onto a pulse oximetry remote monitoring programme, 91% felt participation in the programme was helpful, 87% felt that participation was an important part of their care and 76% felt participation helped manage their symptoms at home [45].…”