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DOI: 10.1055/s-0040-1721039
Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients
Abstract
Objective We deployed a Remote Patient Monitoring (RPM) program to monitor patients with coronavirus disease 2019 (COVID-19) upon hospital discharge. We describe the patient characteristics, program characteristics, and clinical outcomes of patients in our RPM program.
Methods We enrolled COVID-19 patients being discharged home from the hospital. Enrolled patients had an app, and were provided with a pulse oximeter and thermometer. Patients self-reported symptoms, O2 saturation, and temperature daily. Abnormal symptoms or vital signs were flagged and assessed by a pool of nurses. Descriptive statistics were used to describe patient and program characteristics. A mixed-effects logistic regression model was used to determine the odds of a combined endpoint of emergency department (ED) or hospital readmission.
Results A total of 295 patients were referred for RPM from five participating hospitals, and 225 patients were enrolled. A majority of enrolled patients (66%) completed the monitoring period without triggering an abnormal alert. Enrollment was associated with a decreased odds of ED or hospital readmission (adjusted odds ratio: 0.54; 95% confidence interval: 0.3–0.97; p = 0.039). Referral without enrollment was not associated with a reduced odds of ED or hospital readmission.
Conclusion RPM for COVID-19 provides a mechanism to monitor patients in their home environment and reduce hospital utilization. Our work suggests that RPM reduces readmissions for patients with COVID-19 and provides scalable remote monitoring capabilities upon hospital discharge. RPM for postdischarge patients with COVID-19 was associated with a decreased risk of readmission to the ED or hospital, and provided a scalable mechanism to monitor patients in their home environment.
Keywords
remote patient monitoring - coronavirus disease 2019 - patient outcome assessment - remote sensing technologyAuthors' Contributions
W.J.G. was involved in article conception. W.J.G., A.D., J.J., M.Y.S., L.M., and D.S. were involved in data collection. W.J.G., D.H., A.D., D.M.L., L.M., D.S., and R.B. were involved in data interpretation and visualization. W.J.G., D.M.L., D.H., and R.B. were involved in statistical analysis. W.J.G. wrote the manuscript draft. All authors were involved in critical revisions, editing, and manuscript approval.
Protection of Human and Animal Subjects
The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and as a quality improvement project, the MassGeneral Brigham IRB exempted this study from review.
Publication History
Received: 11 August 2020
Accepted: 07 October 2020
Article published online:
25 November 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
-
1
World Health Organization.
WHO coronavirus disease (COVID-19) dashboard. Available at: https://COVID19.who.int/. Accessed July 20, 2020
- 2 Helmy YA, Fawzy M, Elaswad A, Sobieh A, Kenney SP, Shehata AA. The COVID-19 pandemic: a comprehensive review of taxonomy, genetics, epidemiology, diagnosis, treatment, and control. J Clin Med 2020; 9 (04) E1225
- 3 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513
- 4 White DB, Lo B. A framework for rationing ventilators and critical care beds during the COVID-19 pandemic. JAMA 2020; 323 (18) 1773-1774
-
5
Kliff S.
Hospitals knew how to make money. Then coronavirus happened. The New York Times. Available at: https://www.nytimes.com/2020/05/15/us/hospitals-revenue-coronavirus.html. Published May 15, 2020. Accessed July 20, 2020
-
6
Reuters.
California hospitals struggle financially after preparing for COVID-19 surge that never came. The New York Times. Available at: https://www.nytimes.com/reuters/2020/05/28/us/28reuters-health-coronavirus-california-hospitals.html. Published May 28, 2020 Accessed July 20, 2020
- 7 Khullar D, Bond AM, Schpero WL. COVID-19 and the financial health of US hospitals. JAMA 2020; 323 (21) 2127-2128
- 8 Peters AW, Chawla KS, Turnbull ZA. Transforming ORs into ICUs. N Engl J Med 2020; 382 (19) e52
- 9 Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA 2020; 323 (16) 1545-1546
- 10 Webster P. Virtual health care in the era of COVID-19. Lancet 2020; 395 (10231): 1180-1181
- 11 Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016; 375 (02) 154-161
- 12 Schwamm LH, Erskine A, Licurse A. A digital embrace to blunt the curve of COVID19 pandemic. NPJ Digit Med 2020; 3 (01) 64
- 13 Hollander JE, Carr BG. Virtually perfect? Telemedicine for COVID-19. N Engl J Med 2020; 382 (18) 1679-1681
- 14 Shachar C, Engel J, Elwyn G. Implications for telehealth in a postpandemic future: regulatory and privacy issues. JAMA 2020; 323 (23) 2375-2376
- 15 Annis T, Pleasants S, Hultman G. et al. Rapid Implementation of a COVID-19 Remote Patient Monitoring Program. J Am Med Inform Assoc JAMIA Published online May 11, 2020
- 16 Noah B, Keller MS, Mosadeghi S. et al. Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials. NPJ Digit Med 2018; 1: 20172
- 17 Vegesna A, Tran M, Angelaccio M, Arcona S. Remote patient monitoring via non-invasive digital technologies: a systematic review. Telemed J E Health 2017; 23 (01) 3-17
- 18 Daley CN, Chen EM, Roebuck AE. et al. Providing patients with implantable cardiac device data through a personal health record: a qualitative study. Appl Clin Inform 2017; 8 (04) 1106-1116
- 19 Ahmed R, Toscos T, Rohani Ghahari R. et al. Visualization of cardiac implantable electronic device data for older adults using participatory design. Appl Clin Inform 2019; 10 (04) 707-718
- 20 Fisher NDL, Fera LE, Dunning JR. et al. Development of an entirely remote, non-physician led hypertension management program. Clin Cardiol 2019; 42 (02) 285-291
- 21 Koehler F, Winkler S, Schieber M. et al; Telemedical Interventional Monitoring in Heart Failure Investigators. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation 2011; 123 (17) 1873-1880
- 22 Pevnick JM, Fuller G, Duncan R, Spiegel BMR. A Large-scale initiative inviting patients to share personal fitness tracker data with their providers: initial results. PLoS One 2016; 11 (11) e0165908
- 23 Ong MK, Romano PS, Edgington S. et al; Better Effectiveness After Transition–Heart Failure (BEAT-HF) Research Group. Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the better effectiveness after transition – heart failure (BEAT-HF) randomized clinical trial. JAMA Intern Med 2016; 176 (03) 310-318
- 24 Wallace EL, Rosner MH, Alscher MD. et al. Remote patient management for home dialysis patients. Kidney Int Rep 2017; 2 (06) 1009-1017
- 25 Lee PA, Greenfield G, Pappas Y. The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials. BMC Health Serv Res 2018; 18 (01) 495
- 26 Tomasic I, Tomasic N, Trobec R, Krpan M, Kelava T. Continuous remote monitoring of COPD patients-justification and explanation of the requirements and a survey of the available technologies. Med Biol Eng Comput 2018; 56 (04) 547-569
- 27 Docherty AB, Harrison EM, Green CA. et al; ISARIC4C investigators. Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020; 369: m19
- 28 Richardson S, Hirsch JS, Narasimhan M. et al; the Northwell COVID-19 Research Consortium. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020; 323 (20) 2052-2059
- 29 Goyal P, Choi JJ, Pinheiro LC. et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med 2020; 382 (24) 2372-2374
- 30 Medina M, Babiuch C, Card M. et al. Home monitoring for COVID-19. Cleve Clin J Med 2020;
-
31
Sinai M.
Health System.
Mount Sinai uses remote patient monitoring to rapidly respond to COVID-19. Published April 6, 2020. Available at: https://www.newswise.com/coronavirus/mount-sinai-uses-remote-patient-monitoring-to-rapidly-respond-to-COVID-19/?article_id=729377. Accessed July 20, 2020
-
32
Landi H.
Providence St. Joseph using Twistle remote monitoring technology for 700 COVID patients. Published April 1, 2020. Available at: https://www.fiercehealthcare.com/tech/providence-using-twistle-remote-monitoring-technology-for-700-COVID-patients. Accessed July 20, 2020
- 33 Park PG, Kim CH, Heo Y, Kim TS, Park CW, Kim CH. Out-of-hospital cohort treatment of coronavirus disease 2019 patients with mild symptoms in Korea: an experience from a single community treatment center. J Korean Med Sci 2020; 35 (13) e140
- 34 Grutters LA, Majoor KI, Mattern ESK, Hardeman JA, van Swol CFP, Vorselaars ADM. Home telemonitoring makes early hospital discharge of COVID-19 patients possible. J Am Med Inform Assoc JAMIA Published online July 15, 2020
- 35 Hron JD, Parsons CR, Williams LA, Harper MB, Bourgeois FC. Rapid implementation of an inpatient telehealth program during the COVID-19 pandemic. Appl Clin Inform 2020; 11 (03) 452-459
- 36 Grange ES, Neil EJ, Stoffel M. et al. Responding to COVID-19: The UW medicine information technology services experience. Appl Clin Inform 2020; 11 (02) 265-275
-
37
Massachusetts.
COVID-19 Response reporting. Published June 8, 2020. Available at: https://www.mass.gov/info-details/COVID-19-response-reporting. Accessed July 20, 2020
- 38 Chen J, Qi T, Liu L. et al. Clinical progression of patients with COVID-19 in Shanghai, China. J Infect 2020; 80 (05) e1-e6
- 39 Wootton R. Twenty years of telemedicine in chronic disease management--an evidence synthesis. J Telemed Telecare 2012; 18 (04) 211-220
- 40 Chaudhry SI, Mattera JA, Curtis JP. et al. Telemonitoring in patients with heart failure. N Engl J Med 2010; 363 (24) 2301-2309
- 41 Bashi N, Karunanithi M, Fatehi F, Ding H, Walters D. Remote monitoring of patients with heart failure: an overview of systematic reviews. J Med Internet Res 2017; 19 (01) e18
- 42 Inglis SC, Clark RA, McAlister FA, Stewart S, Cleland JGF. Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: Abridged Cochrane Review. Eur J Heart Fail 2011; 13 (09) 1028-1040
- 43 Hameed AS, Sauermann S, Schreier G. The impact of adherence on costs and effectiveness of telemedical patient management in heart failure: a systematic review. Appl Clin Inform 2014; 5 (03) 612-620
- 44 Ralston JD, Cook AJ, Anderson ML. et al. Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control: a mediation analysis. Appl Clin Inform 2014; 5 (01) 232-248
-
45
Kricke G,
Roemer PE,
Barnard C.
et al.
Rapid implementation of an outpatient COVID-19 monitoring program. NEJM Catal Innov Care Deliv. Published online June 16, 2020. Available at: https://catalyst.nejm.org/doi/abs/10.1056/cat.20.0214. Accessed June 28, 2020
- 46 Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with COVID-19. N Engl J Med 2020; 382 (26) 2534-2543
- 47 Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis Off Publ Infect Dis Soc Am . Published online June 20, 2020
- 48 Greenaway C, Hargreaves S, Barkati S. et al. COVID-19: exposing and addressing health disparities among ethnic minorities and migrants. J Travel Med 2020; taaa113
-
49
Jimenez CR.
New Bostonians demographic report. Available at: https://www.cityofboston.gov/newbostonians/pdfs/dem_report.pdf. Accessed September 11, 2020