Hospital at Home for Elderly COVID-19 Patients: A Preliminary Report with 100 Patients

Miyamoto, Yuki; Matsuyama, Tasuku; Kunimitsu, Katsutomo; Nagano, Hiroyuki; Yamada, Yoshie; Murakami, Shigemi; Yamahata, Yoshihiro; Ohta, Bon; Morikami, Yoshiki; Nakagawa, Masanori

doi:10.3390/jcm11071850

Cited by 9 publications

(21 citation statements)

References 24 publications

(31 reference statements)

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“…Consistent with previous studies, our results showed that our HaH care model for COVID-19 patients is a useful alternative to alleviate the shortage of hospital staff and beds (7, 9-12). We further suggested that such models could be built by multiple clinics that normally provide primary care services.…”

Section: Discussionsupporting

confidence: 92%

“…To reduce the burden on hospitals, it is crucial to triage the patients who require immediate hospitalization and to provide care for COVID-19 patients in the primary care setting rather than in hospital. We previously reported the usefulness of HaH care without hospital visits for elderly COVID-19 patients in Kyoto city (12). This provision of HaH care in a primary care clinic that combines the functions of triage and inpatient care is unique worldwide.…”

Section: Introductionmentioning

confidence: 99%

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A novel hospital-at-home model for patients with COVID-19 built by a team of local primary care clinics and clinical outcomes: A multi-center retrospective cohort study

Tsujimoto

Kobayashi²,

Oku³

et al. 2022

Preprint

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Background Hospital-at-home (HaH) care has been proposed as an alternative to inpatient care for patients with COVID-19. Previous reports were hospital-led and involved patients triaged at the hospitals. To reduce the burden on hospitals, we constructed a novel HaH care model organised by a team of local primary care clinics. Methods We conducted a multi-center retrospective cohort study of the COVID-19 patients who received our HaH care from Jan 1st to Mar 31st, 2022. Patients who were not able to be triaged for the need for hospitalization by the Health Center solely responsible for the management of COVID-19 patients in Osaka City were included. The primary outcome was receiving medical care beyond the HaH care defined as a composite outcome of any medical consultation, hospitalization, or death within 30 days from the initial treatment. Results Of 382 eligible patients, 34 (9%) were triaged for hospitalization immediately after the initial visit. Of the remaining 348 patients followed up, 37 (11%) developed the primary outcome, while none died. Obesity, fever, and gastrointestinal symptoms at baseline were independently associated with an increased risk of needing medical care beyond the HaH care. A further 129 (37%) patients were managed online alone without home visit, and 170 (50%) required only one home visit in addition to online treatment. Conclusions The HaH care model with a team of primary care clinics was able to triage patients with COVID-19 who needed immediate hospitalization without involving hospitals, and treated most of the remaining patients at home.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

A novel hospital-at-home model for patients with COVID-19 built by a team of local primary care clinics and clinical outcomes: A multi-center retrospective cohort study

Tsujimoto

Kobayashi²,

Oku³

et al. 2022

Preprint

Self Cite

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“…In addition, the high case-fatality rate of patients during the Alpha wave may be because the service catered to old patients during this period. Previous studies have reported the establishment of HaHs during the COVID-19 pandemic [ 8 , 22 , 23 , 24 ]; one HaH service treated moderate COVID-19 patients [ 8 , 24 ], whereas others treated old and severe patients [ 23 ]. The young age and low case-fatality rate among patients treated by the AHHC service during the Delta wave was reflective of the national trend [ 25 ] and is thought to be primarily attributable to the success of vaccination, rather than an improvement in the AHHC service.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Characteristics and Outcomes of COVID-19 Patients Treated by a Hospital-at-Home Service in Japan during the Alpha and Delta Waves

Inokuchi

Jin

Iwagami

et al. 2022

JCM

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Coronavirus infections occurred in repeated waves caused by different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with the number of patients increasing during each wave. A private after-hours house-call (AHHC) service provides hospital-at-home (HaH) services to patients in Japan requiring oxygen when hospital beds are in short supply. This retrospective study aimed to compare the characteristics of COVID-19 patients treated by the AHHC service during the COVID-19 waves caused by the Alpha (March–June 2021) and Delta (July–December 2021) SARS-CoV-2 variants. All patients with COVID-19 treated by the AHHC service from March to December 2021 while awaiting hospitalization were included. The data were collected from medical records and follow-up telephone interviews. The AHHC service treated 55 and 273 COVID-19 patients during the Alpha and Delta waves, respectively. The patients treated during the Delta wave were significantly younger than those treated during the Alpha wave (median: 63 years and 47 years, respectively; p < 0.001). Disease severity did not differ significantly between the two waves, but the crude case-fatality rate was significantly higher during the Alpha wave (10/55, 18.2%) than during the Delta wave (4/273, 1.4%; p < 0.001). The patient characteristics and outcomes differed between the Alpha and Delta waves.

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“…Many of the oxygen monitoring programmes also existed as part of a wider package of remote monitoring, for example, including thermometers and blood pressure devices or including additional symptom monitoring [29 & ]. Supplemental oxygen therapy has been described as part of relatively few remote monitoring pathways, used either to prevent the need for admission to hospital or to facilitate early supported discharge from hospital [16,[30][31][32]. Some pathways were designed solely for those requiring home oxygen therapy, whereas others offered home oxygen therapy as part of a wider oximetry monitoring programme.…”

Section: Purpose and Scope Of Home Oxygen Monitoring And Therapy Prog...mentioning

confidence: 99%

“…Supplemental oxygen therapy has been described as part of relatively few remote monitoring pathways, used either to prevent the need for admission to hospital or to facilitate early supported discharge from hospital [ 16 , 30 – 32 ]. Some pathways were designed solely for those requiring home oxygen therapy, whereas others offered home oxygen therapy as part of a wider oximetry monitoring programme.…”

Section: Purpose and Scope Of Home Oxygen Monitoring And Therapy Prog...mentioning

confidence: 99%

Home oxygen monitoring and therapy: learning from the pandemic

Beaney¹,

Clarke

2022

Current Opinion in Critical Care

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Purpose of review Home oxygen monitoring and therapy have been increasingly used in the management of patients with chronic diseases. The COVID-19 pandemic has prompted the rapid uptake of remote monitoring programmes to support people with COVID-19 at home. This review discusses the recent evidence and learning in home oxygen monitoring and therapy from the pandemic. Recent findings Many home oxygen monitoring programmes were established around the world during the pandemic, mostly in high-income countries to support early detection of hypoxaemia and/or early hospital discharge. The characteristics of these programmes vary widely in the type of monitoring (self-monitoring or clinician-monitoring) and the patient risk groups targeted. There is a lack of evidence for benefits on clinical outcomes, including mortality, and on reductions in healthcare utilisation or cost-effectiveness, but programmes are viewed positively by patients. Recent studies have highlighted the potential bias in pulse oximetry in people with darker skin. Summary Recent evidence indicates that home oxygen monitoring therapy programmes are feasible in acute disease, but further research is needed to establish whether they improve patient outcomes, are cost-effective and to understand their equity impact.

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Hospital at Home for Elderly COVID-19 Patients: A Preliminary Report with 100 Patients

Cited by 9 publications

References 24 publications

A novel hospital-at-home model for patients with COVID-19 built by a team of local primary care clinics and clinical outcomes: A multi-center retrospective cohort study

A novel hospital-at-home model for patients with COVID-19 built by a team of local primary care clinics and clinical outcomes: A multi-center retrospective cohort study

Comparison of the Characteristics and Outcomes of COVID-19 Patients Treated by a Hospital-at-Home Service in Japan during the Alpha and Delta Waves

Home oxygen monitoring and therapy: learning from the pandemic

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