Appl Clin Inform 2020; 11(05): 792-801
DOI: 10.1055/s-0040-1721039
Research Article

Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients

William J. Gordon
1  Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
2  Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
3  Harvard Medical School, Boston, Massachusetts, United States
,
Daniel Henderson
3  Harvard Medical School, Boston, Massachusetts, United States
4  Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Avital DeSharone
4  Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Herrick N. Fisher
1  Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
3  Harvard Medical School, Boston, Massachusetts, United States
,
Jessica Judge
1  Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
David M. Levine
1  Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
3  Harvard Medical School, Boston, Massachusetts, United States
,
Laura MacLean
5  Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Diane Sousa
5  Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Mack Y. Su
3  Harvard Medical School, Boston, Massachusetts, United States
,
Robert Boxer
1  Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
3  Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations

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.

Authors' 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

Publication Date:
25 November 2020 (online)

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