The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.
NIHR Applied Research Collaboration Greater Manchester, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
PLoS One. 2024 Nov 15;19(11):e0310822. doi: 10.1371/journal.pone.0310822. eCollection 2024.
The pandemic saw widespread use of home pulse oximeters to patients diagnosed with COVID-19 to support early detection of low oxygen saturation levels and appropriate care. Rapid implementation made conventional evaluation challenging, highlighting the need for rigorous non-randomised methods to support decision-making about future use of these technologies. We used routine data to explore the benefits of pulse oximetry in Greater Manchester, under the 'COVID-19 oximetry at home' (CO@h) programme.
We used data from the Greater Manchester Secure Data Environment and defined study parameters using a 'target trial' model to compare patients receiving pulse oximetry under the CO@h programme, with matched controls using various comparator groups. Primary outcomes were unplanned hospitalisation and all-cause mortality. This study is based on data from the Greater Manchester Care Record (GMCR), using anonymised, routinely collected data provided in a de-identified format for research. Informed written consent is needed for primary care patient data to be collected for service improvement and research, before data extraction to the GMCR. The study was approved under protocol GMCR RQ-048, on 12/05/2022. As indicated by the University of Manchester ethics decision tool, formal ethical approval was not required for this study.
The adjusted odds ratios for an unplanned hospitalisation were higher among patients receiving pulse oximetry: OR 1.86 (95% CI 1.54-2.25) at 28 days, 1.5 (95% CI 1.3-1.74) at 90 days and 1.63 (95% CI 1.44-1.83) at 1 year. Overall odds of mortality were lower among patients receiving pulse oximetry: adjusted ORs of 0.5 (95% CI 0.25-0.98) at 28 days, 0.5 (95% CI 0.32-0.78) at 90 days and 0.58 (95% CI 0.44-0.76) at 1 year. The results were robust to different comparison groups.
Use of pulse oximetry at home under the CO@h programme, through the resulting prioritisation for appropriate care, was associated with a higher frequency of unplanned admissions and a reduction in the risk of mortality up to 1 year later. Therefore, it is likely effective for early detection of clinical deterioration and timely intervention among patients with COVID-19. Further research is needed to understand whether this is a cost-effective use of healthcare resources.
在 COVID-19 大流行期间，广泛使用家用脉搏血氧仪来监测已确诊 COVID-19 患者，以支持早期发现低血氧饱和度并提供适当的护理。快速实施使常规评估具有挑战性，这凸显了需要使用严格的非随机方法来支持关于未来使用这些技术的决策。我们使用常规数据来探索大曼彻斯特地区脉搏血氧仪的益处，该研究是在“COVID-19 家庭脉搏血氧仪”（CO@h）计划下进行的。
我们使用了大曼彻斯特安全数据环境的数据，并使用“目标试验”模型定义了研究参数，以比较在 CO@h 计划下接受脉搏血氧仪监测的患者与使用各种对照组的匹配对照患者。主要结局是无计划住院和全因死亡率。本研究基于大曼彻斯特护理记录（GMCR）的数据，使用匿名、常规收集的数据，并以去识别格式提供给 GMCR 进行研究。在提取数据到大曼彻斯特护理记录（GMCR）之前，需要患者的初级保健数据提供服务改进和研究的知情书面同意。该研究已在 2022 年 5 月 12 日获得 GMCR RQ-048 方案的批准。根据曼彻斯特大学伦理决策工具的指示，这项研究不需要正式的伦理批准。
在 28 天、90 天和 1 年时，接受脉搏血氧仪监测的患者发生无计划住院的调整后优势比更高：调整后优势比分别为 1.86（95%置信区间 1.54-2.25）、1.5（95%置信区间 1.3-1.74）和 1.63（95%置信区间 1.44-1.83）。接受脉搏血氧仪监测的患者总体死亡率较低：调整后的比值比分别为 0.5（95%置信区间 0.25-0.98）、0.5（95%置信区间 0.32-0.78）和 0.58（95%置信区间 0.44-0.76）。在 28 天、90 天和 1 年时，结果在不同的对照组中均具有稳健性。
在 CO@h 计划下通过优先考虑适当的护理使用家用脉搏血氧仪与更高频率的无计划入院和降低死亡率相关，可降低 1 年后的死亡风险。因此，它可能对 COVID-19 患者的临床恶化早期检测和及时干预有效。需要进一步研究以了解这是否是一种具有成本效益的医疗资源利用方式。
