COVID Home Monitoring Keeps People Out of the Hospital

By Megan Brooks

May 11, 2021

NEW YORK (Reuters Health) - Participating in a home-monitoring program appears to help patients with COVID-19 avoid hospital admission, according to new U.S. research.

"It was very important to support patients with significant worry about COVID-19 illness especially early on in the pandemic," Dr. Anita Misra-Hebert, director of the Healthcare Delivery and Implementation Science Center at Cleveland Clinic, in Ohio, told Reuters Health by email.

"The goals were to make sure they could access further care if needed and also avoid a further hospitalization. We will continue to monitor patients until this work is no longer needed," Dr. Misra-Hebert said.

Established in spring 2020, Cleveland Clinic's home-monitoring program is an interactive program through which providers remotely monitor patients with COVID-19 for up to 14 days after they test positive.

The research team assessed healthcare utilization patterns for almost 4,000 COVID-19 patients who participated in the program and a similar group of 3,221 patients who did not.

Participation in the program was associated with significantly lower odds of hospitalization at 30 days (odds ratio, 0.73) and 90 days (OR, 0.79), the team reports in JAMA Health Forum.

There was no significant association between participation in the home-monitoring program and 30-day or 90-day emergency department use. But there was about two-fold higher odds of outpatient visits with the home-monitoring program at 30 and 90 days.

"We did not bill for the services in this program and therefore the cost was covered by the organization," Dr. Misra-Hebert told Reuters Health. "As the pandemic continued and we learned more and more about the outcomes of the program, and the natural course of COVID infections in groups of patients, we were able to fine tune the program to those with highest risk, and therefore streamlining the workforce."

"The experience is helping us to determine how we also monitor and manage patients with chronic disease," Dr. Misra-Hebert said.

The authors caution that the results represent the experience of a single health system, and their analytic methods may not have adjusted for all confounders, specifically the choice for enrollment in the program.

The results "support the need for randomized trials to evaluate home monitoring programs and consideration of targeted resource allocation for home monitoring after COVID-19 diagnosis or to other opportunities to maintain the health of patients during the pandemic," they write in their paper.

In a linked editorial, Dr. Alan Zaslavsky with the Department of Health Care Policy, Harvard Medical School, in Boston, cautions that without a control group, the study does not provide "conclusive evidence for the proposed intervention. Nonetheless, it is at least consistent with the desired treatment effect and supports reanalysis with retrospectively identified controls or a new prospectively controlled study."

The study was internally funded by the Healthcare Delivery and Implementation Science Center at Cleveland Clinic.

SOURCE: https://bit.ly/3uvHpyW and https://bit.ly/3bdJg3L JAMA Health Forum, online May 6, 2021.

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