Hospitalization Outcomes Among Patients With COVID-19 Undergoing Remote Monitoring. JAMA Netw Open 2022 Jul 01;5(7):e2221050
Date
07/08/2022Pubmed ID
35797044Pubmed Central ID
PMC9264036DOI
10.1001/jamanetworkopen.2022.21050Scopus ID
2-s2.0-85133959055 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
IMPORTANCE: Health care systems have implemented remote patient monitoring (RPM) programs to manage patients with COVID-19 at home, but the associations between participation and outcomes or resource utilization are unclear.
OBJECTIVE: To assess whether an RPM program for COVID-19 is associated with lower or higher likelihood of hospitalization and whether patients who are admitted present earlier or later for hospital care.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, observational, cohort study of RPM was performed at Froedtert & Medical College of Wisconsin Health Network, an academic health system in southeastern Wisconsin. Participants included patients with internal primary care physicians and a positive SARS-CoV-2 test in the ambulatory setting between March 30, 2020, and December 15, 2020. Data analysis was performed from February 15, 2021, to February 2, 2022.
EXPOSURES: Activation of RPM program.
MAIN OUTCOMES AND MEASURES: Hospitalizations within 2 to 14 days of a positive test. Inverse propensity score weighting was used to account for differences between groups. Sensitivity analyses were performed looking at usage of the RPM among patients who activated the program.
RESULTS: A total of 10 660 COVID-19-positive ambulatory patients were eligible, and 9378 (88.0%) had email or mobile numbers on file and were invited into the RPM program; the mean (SD) age was 46.9 (16.3) years and 5448 patients (58.1%) were women. Patients who activated monitoring (5364 patients [57.2%]) had a mean (SD) of 35.3 (33.0) check-ins and a mean (SD) of 1.27 (2.79) (median [IQR], 0 [0-1]) free-text comments. A total of 878 patients (16.4%) experienced at least 1 alert; 128 of 5364 activated patients (2.4%) and 158 of 4014 inactivated patients (3.9%) were hospitalized (χ21 = 18.65; P < .001). In weighted regression analysis, activation of RPM was associated with a lower odds of hospitalization (odds ratio, 0.68; 95% CI, 0.54-0.86; P = .001) adjusted for demographics, comorbidities, and time period. Monitored patients had a longer mean (SD) time between test and hospitalization (6.67 [3.21] days vs 5.24 [3.03] days), a shorter length of stay (4.44 [4.43] days vs 7.14 [8.63] days), and less intensive care use (15 patients [0.3%] vs 44 patients [1.1%]).
CONCLUSIONS AND RELEVANCE: These findings suggest that activation of an RPM program is associated with lower hospitalization, intensive care use, and length of stay among patients with COVID-19.
Author List
Crotty BH, Dong Y, Laud P, Hanson RJ, Gershkowitz B, Penlesky AC, Shah N, Anderes M, Green E, Fickel K, Singh S, Somai MMAuthors
Bradley H. Crotty MD Associate Professor in the Medicine department at Medical College of WisconsinYilu Dong PhD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Melek Somai MD Assistant Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Cohort StudiesFemale
Hospitalization
Humans
Male
Middle Aged
Retrospective Studies
