Primary Care Population Management for COVID-19 Patients

Abstract

BACKGROUND: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however, up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill. AIM: We developed an innovative population management approach for managing COVID-19 patients remotely. SETTING: Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice. PARTICIPANTS: Our panel consists of 40,000 patients. By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR. Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses. PROGRAM DESCRIPTION: Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely. PROGRAM EVALUATION: Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline; 54 were admitted to hospitals, six of these died, and 40 were discharged. DISCUSSION: Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion.

Front‐Line innovation: Rapid implementation of a nurse‐driven protocol for care of outpatients with COVID‐19

“…Ours is one of a number of virtual care models that arose during the first months of the pandemic in the United States (Annis et al, 2020;Blazey-Martin et al, 2020;Sinha et al, 2020;Wosik et al, 2020 driven by physicians, residents or advanced practice clinicians, our approach relied more heavily on protocolised triage and follow-up by RNs. Another distinction is that our programme rarely used video telehealth despite the wide availability of a video telehealth infrastructure in VA.…”

Paediatric primary care in Germany during the early COVID-19 pandemic: the calm before the storm

“…Population management strategies for COVID-19 have been proposed, but these are not specific for Paediatrics. 23 Paediatric primary care, both in hospital emergency departments and in the community, would benefit from clear testing criteria specific for children and adolescents that incorporate the considerations most relevant for these age groups. On developing these criteria, there are several important differences to adult populations that need to be taken into account.…”

COVID-19’s impact on primary care and related mitigation strategies: A scoping review

“…Strategies to mitigate the impact of COVID-19 on the community, healthcare provision and/or patient outcomes. Twenty-eight studies identified strategies to mitigate COVID-19's impact on communities, healthcare provision, and/or patient outcomes [19][20][21][22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43]45,[48][49][50]. These strategies were classified into the following subthemes: infection prevention and control measures, alternatives/modifications to traditional service delivery or workflow, government policy responses, and education.…”

“…Alternatives/modifications to traditional service delivery or workflow. Twenty-six studies identified alternatives/modifications to convential service delivery or workflow, which mitigated COVID-19 spread in communities, and reduced COVID-19's impact on healthcare provision and/or patient outcomes [19][20][21][22][23][24][25]7,28,30,[32][33][34][35][36][37][38][39][40][41][42][43]45,[48][49][50].…”

“…These alternatives/modifications included shifting from in-person to telemedicine consultations. This shift was implemented to ensure patients continue receiving care in the community, reduce practice footfall and reduce pressure on facility-based healthcare systems [19][20][21][22]28,30,[33][34][35][36]38,39,42,43,45,[48][49][50]. Home care was also provided to patients deemed unsuitable for telemedicine or requiring in-person care [32,38,45,49], and outreach services were implemented to screen and care for vulnerable patients [19,30,32,40,45].…”