IT Innovation Centre, School of Engineering and Computer Science, University of Southampton, Southampton, UK.
IT Innovation Centre, School of Engineering and Computer Science, University of Southampton, Southampton, UK
BMJ Open Qual. 2022 Mar;11(1). doi: 10.1136/bmjoq-2021-001584.
COVID-19 has placed unprecedented demands on hospitals. A clinical service, COVID-19 Oximetry @home (CO@h) was launched in November 2020 to support remote monitoring of COVID-19 patients in the community. Remote monitoring through CO@h aims to identify early patient deterioration and provide timely escalation for cases of silent hypoxia, while reducing the burden on secondary care.
We conducted a retrospective service evaluation of COVID-19 patients onboarded to CO@h from November 2020 to March 2021 in the North Hampshire (UK) community led service (a collaboration of 15 General Practitioner (GP) practices covering 230 000 people). We have compared outcomes for patients admitted to Basingstoke and North Hampshire Hospital who were CO@h patients (COVID-19 patients with home monitoring of oxygen saturation (SpO; n=115), with non-CO@h patients (those directly admitted without being monitored by CO@h (n=633)). Crude and adjusted OR analysis was performed to evaluate the effects of CO@h on patient outcomes of 30-day mortality, Intensive care unit (ICU) admission and hospital length of stay greater than 3, 7, 14 and 28 days.
Adjusted ORs for CO@h show an association with a reduction for several adverse patient outcome: 30-day hospital mortality (p<0.001, OR 0.21, 95% CI 0.08 to 0.47), hospital length of stay larger than 3 days (p<0.05, OR 0.62, 95% CI 0.39 to 1.00), 7 days (p<0.001, OR 0.35, 95% CI 0.22 to 0.54), 14 days (p<0.001, OR 0.22 95% CI, 0.11 to 0.41), and 28 days (p<0.05, OR 0.21, 95% CI 0.05 to 0.59). No significant reduction ICU admission was observed (p>0.05, OR 0.43, 95% CI 0.15 to 1.04). Within 30 days of hospital admission, there were no hospital readmissions for those on the CO@h service as opposed to 8.7% readmissions for those not on the service.
We have demonstrated a significant association between CO@h and better patient outcomes; most notably a reduction in the odds of hospital lengths of stays longer than 7, 14 and 28 days and 30-day hospital mortality.
COVID-19 给医院带来了前所未有的需求。2020 年 11 月推出了一项名为 COVID-19 血氧测定仪@居家（CO@h）的临床服务，旨在支持社区内 COVID-19 患者的远程监测。通过 CO@h 进行远程监测旨在及早发现患者病情恶化，并及时为无症状低氧血症患者提供治疗，同时减轻二级保健的负担。
我们对 2020 年 11 月至 2021 年 3 月期间在北汉普郡（英国）社区主导的服务中接受 CO@h 服务的 COVID-19 患者进行了回顾性服务评估（该服务由 15 家全科医生（GP）实践组成，覆盖 23 万人）。我们比较了在贝辛斯托克和北汉普郡医院住院的 COVID-19 患者的结局，这些患者是 CO@h 患者（接受家庭血氧饱和度（SpO）监测的 COVID-19 患者（n=115），与非 CO@h 患者（直接入院未接受 CO@h 监测的患者（n=633）。进行了未经调整和调整的 OR 分析，以评估 CO@h 对患者 30 天死亡率、重症监护病房（ICU）入院和住院时间超过 3、7、14 和 28 天的影响。
CO@h 的调整后 OR 显示与以下几个不良患者结局的降低有关：30 天医院死亡率（p<0.001，OR 0.21，95%CI 0.08 至 0.47）、住院时间超过 3 天（p<0.05，OR 0.62，95%CI 0.39 至 1.00）、7 天（p<0.001，OR 0.35，95%CI 0.22 至 0.54）、14 天（p<0.001，OR 0.22，95%CI，0.11 至 0.41）和 28 天（p<0.05，OR 0.21，95%CI，0.05 至 0.59）。ICU 入院率未见显著降低（p>0.05，OR 0.43，95%CI 0.15 至 1.04）。在住院后 30 天内，接受 CO@h 服务的患者中没有医院再次入院，而未接受该服务的患者中有 8.7%再次入院。
我们已经证明了 CO@h 与更好的患者结局之间存在显著关联；最显著的是降低了住院时间超过 7、14 和 28 天以及 30 天医院死亡率的几率。
