COVIDCare@Home: Lessons from a Family Medicine Led Remote Monitoring Program

Agarwal, Payal; Mukerji, Geetha; Laur, Celia; Chandra, Shivani; Pimlott, Nicholas; Heisey, Ruth; Stovel, Rebecca; Goulbourne, Elaine; Bhatia, R Sacha; Bhattacharyya, Onil; Martin, Danielle

doi:10.1101/2020.07.20.20158386

Cited by 8 publications

(14 citation statements)

References 19 publications

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“…Three studies included some degree of detail in relation to the categorisation of patients in relation to risk 14 17 18 . The article by O’Keefe and colleagues 12 described and evaluated a risk assessment model based on age, medical history and symptom severity.…”

Section: Resultsmentioning

confidence: 99%

“…Remote home monitoring process outcomes were only included in six of the articles, with time from swab to assessment ranging from 2 to 3.7 days 12 17 19 and virtual length of stay from 3.5 days to 13 days (see Table 3). Only one article presented findings on reduction in length of stay, calculated at 5 days fewer per patient 21 .…”

Section: Resultsmentioning

confidence: 99%

“…Most of the models included in the study were led by secondary care but some authors argued that coordination between primary and secondary care could facilitate the implementation of remote home monitoring pathways 5 7 13 . Primary care led models might be more adaptable to evolving patient and system needs and easier to replicate in contexts with limited secondary care access and capacity 17 . Three models integrated mental health and social care support during and after patient monitoring, highlighting a wide range of patient needs 6 13 17 .…”

Section: Discussionmentioning

confidence: 99%

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Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

Vindrola‐Padros

et al. 2020

Preprint

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Objectives: The aim of this review was to analyse the implementation and impact of remote home monitoring models (virtual wards) during COVID-19, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. Design: The review was designed as a rapid systematic review to capture an evolving evidence base. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Setting: The review included models led by primary and secondary care across seven countries. Participants: 17 examples of models were included in the review. Main outcome measures: Impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. Results: The aim of the models was to maintain patients safe in the right setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/carer training was identified as a determining factor of success. We could not reach conclusions regarding patient safety and the identification of early deterioration due to lack of standardised reporting and missing data. Economic analysis was not reported beyond how the resources were used. Conclusions: Future research should focus on staff and patient experiences of care and inequalities in patients access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators and the use of risk-stratification tools. Protocol registration: The review protocol was published on PROSPERO (CRD: 42020202888).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

Vindrola‐Padros

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Personalised support might be required to avoid patient anxiety and reach those who may be difficult to monitor remotely. Remote home monitoring models in the US and Canada, for instance, also screened patients for mental health and social care needs, providing a more holistic model of patient care 4 17 .…”

Section: Discussionmentioning

confidence: 99%

The implementation of remote home monitoring models during the COVID-19 pandemic in England

Vindrola‐Padros

Sidhu

Georghiou

et al. 2020

Preprint

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ObjectiveThere is a paucity of evidence for the implementation of remote home monitoring for COVID-19 infection. The aims of this study were to: identify the key characteristics of remote home monitoring models for COVID-19 infection, explore the experiences of staff implementing these models, understand the use of data for monitoring progress against outcomes, and document variability in staffing and resource allocation.MethodsThis was a multi-site mixed methods study that combined qualitative and quantitative approaches to analyse the implementation and impact of remote home monitoring models during the first wave of the COVID-19 pandemic (March to August 2020). The study combined interviews (n=22) with staff delivering these models across eight sites in England with the collection and analysis of data on staffing models and resource allocation.ResultsThe models varied in relation to the healthcare settings and mechanisms used for patient triage, monitoring and escalation. Implementation was embedded in existing staff workloads and budgets. Good communication within clinical teams, culturally-appropriate information for patients/carers and the combination of multiple approaches for patient monitoring (app and paper-based) were considered facilitators in implementation. The mean cost per monitored patient varied from £400 to £553, depending on the model.ConclusionsIt is necessary to provide the means for evaluating the effectiveness of these models, for example, by establishing comparator data. Future research should also focus on the sustainability of the models and patient experience (considering the extent to which some of the models exacerbate existing inequalities in access to care).STRENGTHS AND LIMITATIONS OF THE STUDYThe study makes a contribution to existing evidence on remote home monitoring models by exploring the design and implementation of these models for confirmed or suspected COVID-19 cases.The study was carried out across eight remote home monitoring models implemented in England, capturing variability in the mechanisms used for triage, monitoring and escalation.Limited evidence was available to assess the effectiveness of the remote home monitoring models.No comparator data were available for the absence of remote home monitoring.The study was designed as a rapid evaluation and only captured experiences and processes of implementation in a convenience sample of eight models implemented during the first wave of the pandemic in England.

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“…In late March 2020, a virtual clinic, ‘CovidCare@Home’ ( https://www.covidcareathome.ca/ ) ( 13 ) at Women’s College Hospital (WCH) in Toronto, Canada was created to provide virtual assessment and monitoring for community-dwelling people with COVID-19 experiencing mild to moderate illness symptoms. The program was established for people who either did not have their own family physician or who were unable to connect with them in the midst of the pandemic.…”

Section: Introductionmentioning

confidence: 99%

Clinical learnings from a virtual primary care program monitoring mild to moderate COVID-19 patients at home

et al. 2020

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Background Virtual consults have replaced in-person visits for many home-isolated patients with COVID-19 disease. Objectives To describe the natural history, clinical management and outcomes of community-dwelling patients with COVID-19, who received support from a family medicine-led, virtual CovidCare@Home program in Toronto, Ontario, Canada. Methods Observational, descriptive study conducted by retrospective chart review of 98 patients enrolled during the first 5 weeks of program implementation (8 April–11 May 2020); 73 patients with laboratory-confirmed COVID-19, with symptom onset ≤ 14 days before initial consult were included for analysis. Patients were classified as mild, moderate or severe based on WHO Criteria. Results All patients in the program experienced mild (88%) or moderate (12.3%) disease. No patients were hospitalized or died. Patients were mainly female (70%); with mean age of 43.3 years. Most patients (82.2%) worked in higher risk, healthcare settings. Almost 40% had no medical co-morbidities. Common symptoms were cough (65.8%), fatigue (60.3%), headache (42.5%) and myalgia (39.7%), followed by fever (32.9%), sore throat (21.9%), nasal congestion (21.9%) and rhinorrhea (20.5%). Headache (51%) and anosmia (45.1%) were common among females; fever and breathlessness among males (40.9%). Nine patients (12.3%) experienced worsening of symptoms (mainly respiratory) or exacerbation of co-morbidities, which required care outside the virtual service. Conclusion Patients with mild to moderate COVID-19 disease can be managed safely and effectively in a family medicine-led virtual program. Some sex differences in symptoms were observed. Future work should focus on long-term follow up in view of the existence of so-called ‘long-haulers’.

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COVIDCare@Home: Lessons from a Family Medicine Led Remote Monitoring Program

Cited by 8 publications

References 19 publications

Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

The implementation of remote home monitoring models during the COVID-19 pandemic in England

Clinical learnings from a virtual primary care program monitoring mild to moderate COVID-19 patients at home

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