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

Abstract

Background There 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. Methods This was a multi-site mixed methods study conducted between July and August 2020 that combined qualitative and quantitative approaches to analyse the implementation and impact of remote home monitoring models developed during the first wave of the COVID-19 pandemic in England. 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. Findings The 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. Interpretation It 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).

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review

“…Mortality rates were low, admission or readmission rates ranged from 0 to 29%, and ED attendance or reattendance ranged from 4 to 36%. Six of the models reported data on patient feedback, with high satisfaction rates [ 5 , 8 , 18 , 22 , 23 , 24 , 25 , 26 ].…”

“… [27] reported a total cost of $621.8K (equivalent of £485.0K using purchasing power parity) for 621 COVID-19 patients that were monitored using outpatient telehealth follow-up in the Brooklyn Methodist Hospital. These costs included also costs of inpatient follow-up and averaged at £781.0 per monitored patient, whereas the mean cost per monitored patient reported in England varied from £400 to £553 for step-down and pre-hospital models respectively [24] . Some of the selected studies highlighted the fact that, during the pandemic, the intervention used existing resources and staff that were made available due to the emergency situation [ 7 , 12 , 14 , 28 ].…”

Establishing and operating a ‘virtual ward’ system to provide care for patients with COVID-19 at home: experience from The Gambia

“…Second, although this VW system has worked well so far in our setting, as mentioned above, it is not without cost to the MRCG at LSHTM. While many VW systems are embedded within existing healthcare budgets, 22 ensuring their long-term sustainability requires additional funding. Thus, detailed budgeting for additional cost such as data capture systems, telephone communication, internet charges, consumables (thermometers, pulse oximeters, etc) and logistics must be considered before the implementation of the VW system.…”

“…However, the focus of existing literature on COVID-19 VW systems has been the clinical outcomes associated with the system, with less on the experience and processes involved in setting up and operationalising such systems. 22 To the best of our knowledge, there is no literature describing the use of the VW system to support patients with COVID-19 in sub-Saharan African countries. 15 In this practice paper, we hope to bridge this important gap by sharing our experience of setting up and operating a VW system to provide care for patients with COVID-19 in a biomedical research institution in The Gambia, West Africa.…”

Evaluating discharges and readmissions using a COVID Virtual Ward model: a retrospective data study assessing patient outcomes and the likely staffing commitment

“…The authors describe an 11% readmission rate and 1 death. A multi-site mixed methods study assessing clinical sites which had implemented a similar service suggested the cost of implementing such a service was approximately £400 to £553 per patient(5).…”