Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee.
Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee.
JAMA Netw Open. 2022 Jul 1;5(7):e2221050. doi: 10.1001/jamanetworkopen.2022.21050.
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.
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.
Activation of RPM program.
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.
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%]).
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.
医疗保健系统已经实施了远程患者监测 (RPM) 计划，以在家中管理 COVID-19 患者，但参与度与结果或资源利用之间的关联尚不清楚。
评估 COVID-19 的 RPM 计划是否与较低或较高的住院可能性相关，以及入院的患者是否更早或更晚接受医院护理。
设计、设置和参与者：这是一项在威斯康星州东南部弗雷德特和威斯康星医学院健康网络（一个学术医疗系统）进行的 RPM 回顾性、观察性队列研究。参与者包括有内部初级保健医生且在门诊环境中 SARS-CoV-2 检测呈阳性的患者，时间为 2020 年 3 月 30 日至 2020 年 12 月 15 日。数据分析于 2021 年 2 月 15 日至 2022 年 2 月 2 日进行。
RPM 计划的激活。
阳性检测后 2 至 14 天内的住院情况。使用逆倾向评分加权来解释组间差异。对激活该程序的患者中 RPM 的使用情况进行了敏感性分析。
共有 10660 名 COVID-19 阳性门诊患者符合条件，其中 9378 名（88.0%）有电子邮件或手机号码记录并被邀请加入 RPM 计划；平均（SD）年龄为 46.9（16.3）岁，5448 名患者（58.1%）为女性。监测激活的患者（5364 名患者[57.2%]）的平均（SD）检查次数为 35.3（33.0）次，平均（SD）免费文本评论数为 1.27（2.79）（中位数[IQR]，0 [0-1]）。共有 878 名患者（16.4%）至少经历过一次警报；在 5364 名已激活患者中，有 128 名（2.4%）和在 4014 名未激活患者中，有 158 名（3.9%）住院（χ21 = 18.65；P<0.001）。在加权回归分析中，调整了人口统计学、合并症和时间段后，RPM 的激活与较低的住院可能性相关（比值比，0.68；95%置信区间，0.54-0.86；P=0.001）。监测患者的阳性检测与住院之间的平均（SD）时间更长（6.67[3.21]天与 5.24[3.03]天），住院时间更短（4.44[4.43]天与 7.14[8.63]天），重症监护使用率更低（15 名患者[0.3%]与 44 名患者[1.1%]）。
这些发现表明，COVID-19 患者 RPM 计划的激活与较低的住院率、重症监护使用率和住院时间有关。
