Shipman Stacia, Owens Tomas, Gilbertson Chelsey, Shipman Jeffrey
INTEGRIS Southwest Medical Center, Department of Emergency Medicine, Oklahoma City, OK.
INTEGRIS Baptist Medical Center, Department of Family Medicine, Oklahoma City, OK.
J Okla State Med Assoc. 2023 Sep-Oct;116(5):167-171.
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.
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.
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.
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.
2019年新型冠状病毒（COVID-19）引发的大流行使医疗系统不堪重负，急诊科（ED）和医院人满为患。我们的医院系统能够将一部分COVID-19患者送回家，并根据需要进行远程患者监测（RPM）和家庭吸氧（HOME），从而为病情更严重的患者腾出床位。本研究的目的是回顾入选我们项目的患者的全因30天死亡率和入院率，并额外考察其经济影响。
这是一项回顾性队列研究，研究对象为2020年10月27日至2021年9月8日期间在任何INTEGRIS机构接受COVID-19紧急护理且鼻咽拭子SARS-CoV-2 RNA检测呈阳性的急诊科患者。对于主要统计分析，计算描述性统计量并报告为中位数及四分位数间距。为进行经济分析，我们筛选了一部分携带氧气回家的参保患者。
共纳入490例患者，中位年龄为62岁，中位体重指数（BMI）为31。在这490例患者中，151例（占31%）符合家庭吸氧要求并携带氧气出院。在中位入组时间15天内，接受RPM项目从急诊科出院的患者全因30天死亡率为3.2%（95%置信区间，1.8%-5.2%）。观察到的30天内全因住院率为17%。经济分析显示保险公司节省了费用。
本研究表明，为急性COVID-19感染患者迅速部署RPM项目使我们的医疗系统能够安全地在家中护理患者。该项目为需要更密切监测和住院治疗的病情更严重的COVID-19患者腾出了医院床位，同时全因30天死亡率和住院率较低。
