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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Hospital Admission Rates and Mortality Among Emergency Department Patients with COVID-19 Discharged with Remote
Stacia Shipman1, Tomas Owens2, Chelsey Gilbertson1
1INTEGRIS Southwest Medical Center, Department of Emergency Medicine, Oklahoma City, OK.
Insights
Remote patient monitoring (RPM) safely discharged COVID-19 patients home, reducing hospital overcrowding. This approach demonstrated low 30-day mortality and admission rates, while also offering financial benefits.
Area of Science:
- Healthcare Management
- Infectious Diseases
- Telemedicine
Background:
- The COVID-19 pandemic led to widespread emergency department (ED) and hospital overcrowding.
- A remote patient monitoring (RPM) program with home oxygen (HO2ME) was implemented to manage COVID-19 patients, freeing up hospital beds.
- This study aimed to evaluate the 30-day mortality and admission rates, as well as the financial impact, of this RPM program.
Purpose of the Study:
- To assess the safety and efficacy of a remote patient monitoring (RPM) program for COVID-19 patients.
- To determine the all-cause 30-day mortality and hospital admission rates for patients managed under the RPM program.
- To analyze the financial implications of utilizing RPM for COVID-19 care.
Main Methods:
- A retrospective cohort study included patients testing positive for SARS-CoV-2 RNA who received emergency care.
- Patients were discharged home with RPM and optional home oxygen if criteria were met.
- Descriptive statistics were used for analysis, with a focus on insured patients for financial assessment.
Main Results:
- 490 patients were enrolled; 151 (31%) were discharged with home oxygen.
- The 30-day all-cause mortality rate was 3.2% (95% CI, 1.8%-5.2%) for patients in the RPM program.
- The 30-day all-cause hospital admission rate was 17%, with financial savings observed for insurance companies.
Conclusions:
- Rapid deployment of an RPM program enabled safe home care for acute COVID-19 patients.
- The program effectively increased hospital bed availability for critically ill patients.
- Low 30-day mortality and admission rates were achieved, demonstrating the program's success.
Background:
The pandemic caused by the novel Coronavirus 2019 (COVID-19) overwhelmed healthcare systems with emergency department (ED) and hospital overcrowding. Our hospital system was able to discharge a subset of COVID-19 patients home with remote patient monitoring (RPM) and home oxygen (HO2ME) if needed, which opened up beds for the more critical patients. The objective of this study was to review the all-cause 30-day mortality and admission rates for patients chosen for our program, and to additionally examine the financial impact.
Methods:
This was a retrospective cohort study of ED patients who were included if they tested positive for SARS-CoV-2 RNA on nasopharyngeal swab and received emergency care for COVID-19 at any INTEGRIS facility during 10/27/2020-9/8/2021. For the primary statistical analysis, descriptive statistics were calculated and reported as medians with interquartile ranges. For the purpose of financial analysis, we filtered a subset of insured patients who were sent home with oxygen.
Results:
490 patients were enrolled with a median age of 62 and median body mass index (BMI) of 31. Of the 490 patients, 151 patients (31%) met requirements for home oxygen and were discharged with oxygen. Over a median enrollment time of 15 days, patients discharged from the emergency department on the RPM program were observed to have an all-cause 30-day mortality rate of 3.2% (95% Cl, 1.8%-5.2%). The observed rate of all-cause hospital admission within 30 days was 17%. The financial analysis revealed savings to insurance companies.
Conclusions:
This study demonstrated that rapidly deploying a RPM program for patients with acute COVID-19 infection allowed our health system to safely care for patients in their homes. The program opened hospital beds for more severe and critically ill COVID-19 patients who necessitated more intense monitoring and inpatient care, while simultaneously observing low 30-day all-cause mortality and hospital admission rates.
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