van Goor Harriët M R, Breteler Martine J M, van Loon Kim, de Hond Titus A P, Reitsma Johannes B, Zwart Dorien L M, Kalkman Cornelis J, Kaasjager Karin A H
Department of Internal Medicine, University Medical Centre Utrecht, 3584 Utrecht, The Netherlands.
Department of Digital Health, University Medical Centre Utrecht, 3584 Utrecht, The Netherlands.
J Clin Med. 2021 Dec 17;10(24):5940. doi: 10.3390/jcm10245940.
To ensure availability of hospital beds and improve COVID-19 patients' well-being during the ongoing pandemic, hospital care could be offered at home. Retrospective studies show promising results of deploying remote hospital care to reduce the number of days spent in the hospital, but the beneficial effect has yet to be established.
We conducted a single centre, randomised trial from January to June 2021, including hospitalised COVID-19 patients who were in the recovery stage of the disease. Hospital care for the intervention group was transitioned to the patient's home, including oxygen therapy, medication and remote monitoring. The control group received in-hospital care as usual. The primary endpoint was the number of hospital-free days during the 30 days following randomisation. Secondary endpoints included health care consumption during the follow-up period and mortality.
A total of 62 patients were randomised (31 control, 31 intervention). The mean difference in hospital-free days was 1.7 (26.7 control vs. 28.4 intervention, 95% CI of difference -0.5 to 4.2, = 0.112). In the intervention group, the index hospital length of stay was 1.6 days shorter (95% CI -2.4 to -0.8, < 0.001), but the total duration of care under hospital responsibility was 4.1 days longer (95% CI 0.5 to 7.7, = 0.028).
Remote hospital care for recovering COVID-19 patients is feasible. However, we could not demonstrate an increase in hospital-free days in the 30 days following randomisation. Optimising the intervention, timing, and identification of patients who will benefit most from remote hospital care could improve the impact of this intervention.
为确保在当前疫情期间医院病床的可及性并改善新冠肺炎患者的健康状况，可提供居家医院护理。回顾性研究显示，采用远程医院护理以减少住院天数取得了有前景的结果，但这种有益效果尚未得到证实。
我们于2021年1月至6月开展了一项单中心随机试验，纳入处于疾病康复期的住院新冠肺炎患者。干预组的医院护理转移至患者家中，包括氧疗、用药和远程监测。对照组照常接受住院护理。主要终点是随机分组后30天内的非住院天数。次要终点包括随访期间的医疗消耗和死亡率。
共62例患者被随机分组（31例对照组，31例干预组）。非住院天数的平均差异为1.7天（对照组26.7天，干预组28.4天，差异的95%置信区间为-0.5至4.2，P = 0.112）。在干预组中，首次住院的住院时长缩短了1.6天（95%置信区间为-2.4至-0.8，P < 0.001），但医院负责的护理总时长延长了4.1天（95%置信区间为0.5至7.7，P = 0.028）。
对康复期新冠肺炎患者进行远程医院护理是可行的。然而，我们未能证明随机分组后30天内非住院天数有所增加。优化干预措施、时机以及确定最能从远程医院护理中获益的患者，可能会提高这种干预措施的效果。
