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Published on: November 9, 2016
More Accessible COVID-19 Treatment Through Monoclonal Antibody Infusion in the Emergency Department
Sara W Heinert1, Jonathan McCoy1, Pamela Ohman Strickland2
1Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey.
Insights
Emergency department (ED) monoclonal antibody (MAB) infusions increased access for marginalized patients with COVID-19. This approach reached more underserved populations compared to traditional referral models, improving care equity.
Area of Science:
- Health Services Research
- Infectious Diseases
- Health Equity
Background:
- Monoclonal antibody (MAB) infusions are a primary outpatient treatment for COVID-19.
- Social determinants of health create inequities in healthcare access, increasing severe COVID-19 risk for some populations.
- Emergency departments (EDs) can serve as a safety net to improve access to MAB infusions for underserved patients.
Purpose of the Study:
- To examine the characteristics of patients receiving MAB infusions in an ED setting.
- To compare patients who received MAB infusion in the ED after testing positive in the ED versus those referred to the ED from the community.
- To assess the potential of ED-based MAB infusion to reach marginalized populations.
Main Methods:
- A cross-sectional retrospective health record review was conducted for 486 adult patients receiving MAB infusion at Robert Wood Johnson University Hospital ED from November 20, 2020, to March 15, 2021.
- Patients were identified via electronic health records and manual chart review.
- Chi-squared and t-tests were used to compare patient groups.
Main Results:
- Patients testing positive for COVID-19 in the ED and receiving MAB infusion there included higher proportions of Black (18% vs. 6%), Hispanic (19% vs. 11%), Medicaid (12% vs. 9%), and uninsured (17% vs. 8%) individuals.
- These disparities were statistically significant compared to patients tested elsewhere and referred to the ED for infusion.
Conclusions:
- Providing MAB infusions within the ED setting enhances access for patients traditionally marginalized within the healthcare system.
- This model may mitigate risks of prolonged illness and complications from COVID-19 in vulnerable populations.
- ED-based infusion centers can play a crucial role in addressing healthcare inequities for infectious diseases.
Introduction:
Monoclonal antibody (MAB) infusion is the first treatment to manage coronavirus 2019 (COVID-19) in an outpatient setting. Yet increased risk of severe COVID-19 illness may occur from inequities in social determinants of health including access to quality healthcare. Given the safety-net nature of emergency departments (ED), a model that puts them at the center of MAB infusion may better reach underserved patients than models that require physician referral and distribute MAB at outpatient infusion centers. We examined characteristics of two groups of patients who received MAB infusion in the Robert Wood Johnson University Hospital (RWJUH) ED in New Brunswick, New Jersey: 1) patients who tested positive for COVID-19 in the ED and received ED infusion; and 2) patients who tested positive elsewhere and were referred to the ED for infusion. The process for the latter group was similar to the more common national model of patients testing COVID-19 positive in the community and then being referred to an infusion center for MAB therapy.
Methods:
We performed a cross-sectional retrospective health record review of all adult patients presenting to the ED from November 20, 2020-March 15, 2021 who received MAB infusion at RWJUH ED (N = 486). Patients were identified through the electronic health record system by an administrative query, with manual chart review for any additional characteristics not available through the query. We compared the two groups using chi-squared tests for categorical variables and t-tests for continuous variables.
Results:
We found higher proportions of Black (18% vs 6% P < 0.001, statistically significant), Hispanic (19% vs 11% P = 0.02), Medicaid (12% vs 9% P = 0.01), and uninsured (17% vs 8% P = 0.01) patients who tested positive for COVID-19 in their ED visit and then received MAB therapy during their visit than patients tested elsewhere in the community and referred to the ED for MAB therapy.
Conclusion:
These findings suggest that providing MAB infusion in the ED allows increased access for patients traditionally marginalized from the healthcare system, who may be at risk of longer disease duration and complications from COVID-19.
