Hospital Admission Rates and Mortality Among Emergency Department Patients with COVID-19 Discharged with Remote Patient Monitoring with or without HOME - A Value-Based Approach.

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 (HOME) 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.