Pulse Oximetry for Monitoring Patients with Covid-19 at Home — A Pragmatic, Randomized Trial

Lee, Kathleen C.; Morgan, Anna U; Chaiyachati, Krisda H.; Asch, David A.; Xiong, Ruiying; Do, David; Kilaru, Austin S.; Lam, Doreen; Parambath, Andrew; Friedman, Ari B; Meisel, Zachary F.; Snider, Christopher K.; Chisholm, Deena L; Kelly, Sheila; Hemmons, Jessica; Abdel-Rahman, Dina; Ebert, Jeffrey; Ghosh, Medha; Reilly, Julianne; O'Malley, Christina J; Hahn, Lauren; Mannion, Nancy; Huffenberger, Ann Marie; McGinley, Susan; Balachandran, Mohan; Khan, Naazneen; Shea, Judy A.; Mitra, Nandita; Delgado, M Kit

doi:10.1056/nejmc2201541

Cited by 30 publications

(32 citation statements)

References 4 publications

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“…We describe the COVID Watch interventions, including the pulse oximeter trial, in previous publications. 7,10,16 Study Participants And Setting…”

Section: Covid Watch Overviewmentioning

confidence: 99%

“…Patients were recruited via phone between February and June 2021, a timespan that included the randomized controlled trial of ngertip pulse oximetry among COVID Watch enrolled patients. 10 Patients were purposively sampled across two patient-level strata to gain a diversity of patient perspectives on their COVID Watch experience: (a) having a pulse oximetry device mailed to their house (or not), and (b) level of engagement in the program (high vs. low, de ned as responding to twice-daily, automated text message prompts at least 10 out of 14 days of enrollment versus fewer). The cutoffs were based on the median level of engagement.…”

Section: Patient Recruitment and Sampling Strategymentioning

confidence: 99%

“…Interviews were conducted before the publication of COVID Watch's evaluation. 7,10 Interview Guide Development…”

Section: Clinician and Administrator Recruitment And Sampling Strategymentioning

confidence: 99%

“…During the study period, some participants were automatically randomized to receive a home ngertip pulse oximeter or not. 10 Those who received a pulse oximeter were asked to report their symptoms and their ambulatory oxygen saturation levels. Patients whose oxygen saturation, SpO 2 , was below 90% or had decreased by more than 3% and below 95%, were called by the clinical staff who triaged the patient using standardized protocols.…”

Section: Covid Watch Overviewmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9] Our 6-hospital health system with over 500 outpatient practices enrolled adult patients with testcon rmed COVID-19 or symptoms of COVID-19 in COVID Watch, a 14-day remote patient monitoring program which resulted in lower patient mortality compared to matched control patients not enrolled in the program. 7,10 While the program was clinically effective, we elected to ask patients and clinicians how it could be improved. Their perspectives could lead to improvements in this program or in remote engagement programs more generally.…”

mentioning

confidence: 99%

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Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs

Chaiyachati

Shea

Ward

et al. 2022

Preprint

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COVID Watch is a remote patient monitoring program implemented during the pandemic to support home dwelling patients with COVID-19. The program conferred a large survival advantage. We conducted semi-structured interviews of 85 patients and clinicians using COVID Watch to understand how to design such programs even better. Patients and clinicians found COVID Watch to be comforting and beneficial, but both groups desired more clarity about the purpose and timing of enrollment and alternatives to text-messages to adapt to patients’ preferences as these may have limited engagement and enrollment among marginalized patient populations. Because inclusiveness and equity are important elements of programmatic success, future programs will need flexible and multi-channel human-to-human communication pathways for complex clinical interactions or patients who do not desire tech-first approaches.

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“…We describe the COVID Watch interventions, including the pulse oximeter trial, in previous publications. 7,10,16 Study Participants And Setting…”

Section: Covid Watch Overviewmentioning

confidence: 99%

Section: Patient Recruitment and Sampling Strategymentioning

confidence: 99%

“…Interviews were conducted before the publication of COVID Watch's evaluation. 7,10 Interview Guide Development…”

Section: Clinician and Administrator Recruitment And Sampling Strategymentioning

confidence: 99%

Section: Covid Watch Overviewmentioning

confidence: 99%

mentioning

confidence: 99%

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Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs

Chaiyachati

Shea

Ward

et al. 2022

Preprint

Self Cite

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Post-Hospitalization Home Monitoring Programs During the COVID-19 Pandemic: Survey Results from the Hospital Medicine Re-engineering Network (HOMERuN)

Bann,

Manjarrez,

Kellner

et al. 2023

J GEN INTERN MED

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Analysis of Clinical Criteria for Discharge Among Patients Hospitalized for COVID-19: Development and Validation of a Risk Prediction Model

Schnipper,

Oreper,

Hubbard

et al. 2024

J GEN INTERN MED

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Background Patients hospitalized with COVID-19 can clinically deteriorate after a period of initial stability, making optimal timing of discharge a clinical and operational challenge. Objective To determine risks for post-discharge readmission and death among patients hospitalized with COVID-19. Design Multicenter retrospective observational cohort study, 2020–2021, with 30-day follow-up. Participants Adults admitted for care of COVID-19 respiratory disease between March 2, 2020, and February 11, 2021, to one of 180 US hospitals affiliated with the HCA Healthcare system. Main Measures Readmission to or death at an HCA hospital within 30 days of discharge was assessed. The area under the receiver operating characteristic curve (AUC) was calculated using an internal validation set (33% of the HCA cohort), and external validation was performed using similar data from six academic centers associated with a hospital medicine research network (HOMERuN). Key Results The final HCA cohort included 62,195 patients (mean age 61.9 years, 51.9% male), of whom 4704 (7.6%) were readmitted or died within 30 days of discharge. Independent risk factors for death or readmission included fever within 72 h of discharge; tachypnea, tachycardia, or lack of improvement in oxygen requirement in the last 24 h; lymphopenia or thrombocytopenia at the time of discharge; being ≤ 7 days since first positive test for SARS-CoV-2; HOSPITAL readmission risk score ≥ 5; and several comorbidities. Inpatient treatment with remdesivir or anticoagulation were associated with lower odds. The model’s AUC for the internal validation set was 0.73 (95% CI 0.71–0.74) and 0.66 (95% CI 0.64 to 0.67) for the external validation set. Conclusions This large retrospective study identified several factors associated with post-discharge readmission or death in models which performed with good discrimination. Patients 7 or fewer days since test positivity and who demonstrate potentially reversible risk factors may benefit from delaying discharge until those risk factors resolve.

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Pulse Oximetry for Monitoring Patients with Covid-19 at Home — A Pragmatic, Randomized Trial

Cited by 30 publications

References 4 publications

Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs

Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs

Post-Hospitalization Home Monitoring Programs During the COVID-19 Pandemic: Survey Results from the Hospital Medicine Re-engineering Network (HOMERuN)

Analysis of Clinical Criteria for Discharge Among Patients Hospitalized for COVID-19: Development and Validation of a Risk Prediction Model

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