What is the clinical evidence from this study?

Study design: Cohort. Population: COVID-19 (n=1356). Intervention: Remote Patient Monitoring (RPM) program vs. Not referred to the RPM program. Primary outcome: Emergency department (ED) or hospital readmission within 30 days (adjusted OR 0.54, 95% CI 0.3-0.97, p=0.039).

October 1, 2020Applied Clinical Informatics138 citationsOpen Access

Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients

WGWilliam J. GordonBrigham and Women's Hospital DHDaniel HendersonPrince Charles Hospital ADAvital DeSharoneMassachusetts General Hospital

Key Result

Enrollment in a post-discharge Remote Patient Monitoring program for COVID-19 was associated with a significantly decreased odds of 30-day emergency department or hospital readmission (adjusted OR 0.54).

Study Design

Type

Cohort (n=1,356)

Multicenter

Yes

Structured PICO

Does a Remote Patient Monitoring (RPM) program reduce emergency department or hospital readmission in patients with COVID-19 discharged home?

Population

1,356 adult patients with COVID-19 discharged home from five hospitals, followed for 30 days to assess emergency department or hospital readmission.

Intervention

Remote Patient Monitoring (RPM) program using MyChart Care Companion app, a pulse oximeter, and a thermometer for 14 to 21 days post-discharge. Patients self-reported symptoms, oxygen saturation, and temperature daily, with abnormal values triggering assessment by a centralized pool of triage nurses.

Comparator

Usual care (patients discharged home who were not referred to the RPM program, n=1,061).

Outcome

Combined endpoint of emergency department (ED) or hospital readmission within 30 days of the initial discharge.composite

A post-discharge remote patient monitoring program for COVID-19 patients was associated with a significantly reduced risk of 30-day emergency department or hospital readmission.

Main Result

Odds Ratio: 0.54 (95% CI 0.3–0.97)

Absolute Event Rate: 6.2% vs 10.1%

p-value: p=0.039

Limitations

Conducted across five hospitals within a single healthcare system, which may limit generalizability.
Referral to the program was at the discretion of the discharging physician, introducing potential selection bias.
Required a smartphone or desktop computer and internet access, potentially creating structural inequities in access.
Did not evaluate specific associations between survey responses and readmission risk.
Did not assess outcomes beyond readmission, such as overall morbidity and mortality.

Abstract

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.

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